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-~- <br />Certification: <br />As an authorized representative of the applicant, l 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 lmowledge, 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 azea have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S.). <br />2. No training operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applieanUoperator, I do not have any extractionlexploration operations in the Slate of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Constntction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Board finding. <br />4. I 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 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this _~~ day of ~C`ti~ 2~~ ~. <br />C~10~ <br />~i4,y/~u~ r~D d• (Nr.~~ ~~ac. ~S~'~ ~ <br />ApplicanUOperator or Company Name ~ <br />Signed: ~-~ <br />Title: ~itic,-;"•~C`~~ <br />If Corporation Attest (Seal) <br />Signed: <br />State of ~ ~ ~ijy~u.GQb ) <br />ss. <br />County of ~t ~,~ „ti~~ ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ ~ day of F-~~~ ~ l/t G/~~' _,..~~by~~SN ~ ,n <br />S~-P.i~- VYIL~i~o~- as Qr~Si t£~P.~ of .Sc~.~~~n,~Sl~.Dbf ~~tp~~~l <br />J S~~t~`~`t. <br />/ ~ ~~c , <br />#~~~~ <br />Notary public <br />My Commission expires:. 1 L <br />SIGNATURES MUST BE IN BLUE INK <br />