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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minunum <br />requirements of the following terms and conditions: <br />1. To the best of my lmowledge, all signiscant, valuable and permanent man-made structure(s) inexistence 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 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be located ~ lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicant/operator, I donut have a~ extractionlexploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Board finding. <br />4. I undeastand that statements in the application are being made corder penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, CRS. <br />Signed and dated this ~ day of ~ XG[l!/YN C1(JL~ ~_. <br />.~r_-m~~~l~k Cl-~ <br />ApplicantlOperator ~ Company Name <br />If Corporation Attest. (Seal) <br />Signed: ~e~ ~N~f~ <br />/- n ~A / <br />Title: ~(.(A/~ /~lC.l~'IG~atQh/ <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/CitylCounty Clerk <br />State of ~ CD,efJ~~b ) <br />ss <br />County of ~ r. y~Q S ) <br />v r~ <br />The foregoing inctnmlrl*t was aclmowledged before me this day of CP/VU ,A~, <br />by~~ l ~ ~ ~ n u as ~).Q.u~ VYIQ.w~cw~.~_ _ _ of~~r ~/te.C,~C ~D <br />i`iotan• Public <br />My Commission expire~n ~~ 2/4!2006 <br />SIGNATURES MUST SE IlV BLUE INI: <br />M:1minWaeh~ffarmsK:omtroctiw litdoe (10/15/2001) <br />