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<br />-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />I. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-I IS(4xe), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-IIS(4)(f), C.R.S.; <br />3. As the applicanUoperator, 1 do not have any extraction/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation AM for the Extraction of Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board fmding. <br />4. 1 understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this _~_ day of .-lS~v~ ~ bD ~ <br />RAY KILLER, BACA COUNTY COMMISSIONER DISTRICT I <br />ApplicandOperator orCompany Name <br />t np ` <br />/~ r~ <br />0 <br />Title: BACA COUN7R COMMISSIONER DISTRICT I <br />State of _ Colorado <br />Corporate Secretary or Equivalent <br />Town/Ciry/County Clerk <br />ss <br />County of Baca ) <br />The foregoing instrument was acknowledged before me this / gbh day of , ~, <br />by RAY MILLER as COMMISSIONER of BACA COON1'Y DISTRICT I <br />i <br />Notary Public n <br />_ My Commission expires: (~ ~ - ~~- d~- <br />SIGNATURES MUST BE IN BLUE INK <br />If Corporation Attest (Seal) <br />Signed: ~~.. 12.E ~ ~n„ir0.o ~ <br />M:varasrurttvsrortnuuavmix.nrr oviav~s <br />