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-~- <br />Certification: <br />As an authorized representaflve of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of [he following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence a[ [he 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.R.S J. <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-115(4)(t), C.R.S.; <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.R.S.) as determined through a Board fmding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~.3 R-d day of ~ a ~ ~~ <br />~~,tefta-~e~ ~hEEt~c~ -CcJCP ~.tt, <br />A cand for or Co any Name,, ,, 0 <br />Si ed////2~~~ ~ ~i~V~ "~ <br />rn <br />If Corporation t)tfe~t (Seal) <br />Title: Vlc.~ J/~It~BT~cTI ~o~t~J9-L (~ <br />State of ~~ <br />~jy-- Corporate Secretar~Egtuvalent <br />Town/City/Cotmty Clerk <br />ss <br />County of "~-~ <br />The fore oing instrument was acknowledged before m this ~~ ¢-d day of ~o vim- <br />by ~s~p~ /~. ~.(1Q.ra~ as V~~ ~y2~ of -~'~irdC <br />~~° <br />Notary Public <br />~C01. My Commission expires'L~~~ ~a~ <br />SIGNATURES MUST BE IN BLUE INK <br />Sf:U1A~BDC~MINFORMSV.823C0t2APP 10/17/01 <br />