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~- <br />Certifiea6on: <br />As as authorized representative of the applicant, I herclry citify that the operation desaibod has met the minimtan requirements <br />of the following terms and conditi~s: <br />1. To the best of my imowiedge, all significant, valuable and pacmmteatman-made stntctws(s) in e~strnce at the tithe this <br />application is Sled, and locabod within 200 feet of the proposed affected area Gave been identified in this application <br />(Sectioar 3432.3-115(4)(e), C.R.S.). <br />2. No ntining operalian wll be opted aQ lands where such operations are proht'>med by law (Sedian 3432.5-1 IS(4~t), <br />C.RS.; <br />3. As the applicanUoperator, I donut have arty extraotion/exploration operations in the State of Colorado aureaUy in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construdien Materials (Section <br />3432.5-120, C.RS J as determined throagh a Board fording. <br />4. I understand that statements in the application are being made un~r penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant W Section lg-&503, C.RS. <br />5~ ~~~ , <br />Signed and dated this ~_ day of , <br />Platte Sand 6 Gravel LLC <br />Signed: <br />.rte: operations <br />Stated Colorado <br />)~ <br />Cauaryof Jefferson i <br />Town/CirylCoumy Cierk <br />~foregomg iasUnment was aclmowledgea beforepme this ~ ~ ~ day of ~, ~1., <br />~" ' ~ ~~ Vl P.l /~ t /as ~LV~ ~.. i i(~Py of ~~1`1J~ <br />" I <br />o ublic <br />My Commission expires: <br />M:1m~LbeeYa6ma12iLrCpIr.APP (O7l)IIIDDD) <br />SIGNATURES MUST BE IN BLUE INK <br />If Cotporation Attest (Seal) ~O ~~%~/ <br />Signed: ~ _,~~~ <br />rtporaoe rotary m Equivalent <br />```~ ~ ~~ C F F S C / . ~ ~~i i~~w' <br />~P; 'L O <br />S J ~C'tARy ~:~v <br />_ap ~.~ <br />pUB4~G r'~OD~ <br />~~'''iigT~ OF CO~'OeP` <br />~~rpnae)r~~N <br />