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~. <br />r~~ ~~- <br />- ~_ <br />Certification. <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed alPected area have been identified in this application <br />(Section 34-32.5-11~(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-11~(4)(~, <br />C.RS.; <br />3. As the applicant/operator, I do not have any extraction/exploration 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 determuted through a Boazd finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. .. <br />Signed and dated this _ ~ / day of S f ~ ~ ~. ~o ~ ~-GJ -~ . <br />) <br />i <br />C4 )~"~~ CU.., r ~ n .~ C U If Corporation Attest (Beall <br />AppGcantlOperator or Company Name <br />Signed:' / /° <br />Title: (/ y - ~g~~e~~P°• <br />~~ <br />State of 1 "4~.C,~~ 1 <br />ss <br />County of ~i' D pG Ski ) <br />,' <br />,//,,// ) , <br />Signed: ~i~tc.... - <br />Corporate Secretary or Equivalent <br />Towa/CitylCounty Clerk <br />The foregoing instrument was acknowledged before me this ~ ~ day of Ca~[X.~'~ , <br />by C7 ~ 1~a .r vtn a S as 1~. ~ C'i G C/LA ~-~e ~ o ~ACI ,u if /Z, ~/~,,, o ~: ~r <br />~pTARy/SS-~~_ -~ S <br />_~- o Public <br />:'tea <br />:_•.. ... ~ nQ'.~`a My Commission expires: a~- ~o-(~_~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:~Wvehafo~~2i73eOl2.~PP (07/178000) <br />