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~ • • <br />r <br />- <br />Certification: <br />As 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 best 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 39- <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 applicantloperator, 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 18-6-503, C.R.S. <br />Signed and dated this ~~ day of J eri(u'___ 4-s~? ~_. <br /> <br /> <br />Title: <br />State of C E ~~ '.~ c•~ ) <br />ss <br />County of F ~> \ \ ~~ ' ) <br />-~r~/- ~J`r~ Signed: <br />Attest (Seal) <br />e tart' or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this CL day of ~z~C=, 1C1~, <br />b `~ l`:.nKCs_, f as t"t:~Ci i--~ {,,~.~~.~c~ of ~,.,~: i <br />~,,.,,~. ~ l~ .-~.kg~.~,' <br />Notary Public <br />My Commission expires: ~~ )Cq r( <br />SIGNATQAES MIIST HE IN HLIIE INR <br />Ofi /26/97 2823FC0.112 <br />.~:r~ <br />wLY~K-C,t~ 4]84`1 <br />