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-~- <br />Certificatioa: <br />Ae an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. To the beat of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.) <br />as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this \gj_ day of ~~~c \4.~ <br />If Corporation Attest (Seal) <br />Signed• ~ ~ ~ <br />i <br />Corporate S c tary quivalent <br />Town/City/County Clerk <br />The foregoing in~trume <br />nt of nP ~'F <br />ledged before me this r r~ r ~ 1 da <br />y <br />was ackno ~ Z , / ~`j G , <br />' <br />' l <br />~r /)~1 w <br />l <br />~ <br />f~iL[- <br />J <br />~ <br />~ <br />f' /1/ <br />S <br />' <br />~ <br />~ <br />, ~r ' <br />l <br />~ <br />by ~ i~i~ <br />1~a( lrl ,,.^Q <br />n <br />l,rr <br />:) <br />of k <br />as rI <br />F~ <br />~, <br />r.ciP <br />C vc d,.~ <br />i• <br />%/ <br />.l <br /> <br />r <br />Notary Public <br />My Commission expires: ~~' f. ,~ 7, / ~ 2c~5 <br />SIGlIATORES !LOST BS BLOE INR <br />01/02/% 2823FC0.112 <br /> <br />State of ~!,~,~ G 7 n!~ (.~ ) <br />t^ ) ss <br />County of G~ ~~ ,~~11.U ~ ) <br />