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-~- <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 teams and conditions: <br />1. To the best of my knowledge, all significant, valuable and permm~ffit man-made stnrcnne(s) in exi~cace at the time this <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 3432.5-115(4)(e), C.RS.). . <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 3432.5-115(4xf), <br />C.RS.; <br />3. As the applicant/operator, I do not have any extraction/explaration operations in the State of Colorado carrrently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />3432.5-120, C.RS.) as determined through a Board finding. <br />4. I understand that ~atanrnts in the application are being made under penalty of perjury a~ that false statements made <br />herein are punishable as a Class 1 misdemeanor p(rcsuant to Section 18-8-503, C.RS. <br />Sig~oed and datedthis -~---day of ~~~ Q y , .~~. <br />Suburban Sand and Gravel Co. <br />ApplicandOperator or Company Name <br />Signed: <br />Title: President <br />State of Colorado ~ <br />)~ <br />County of Jefferson ~ <br />moo`"~"~?~~y•. <br />~w~s. ~--~` :~ <br />If Corporation At~~-,, <br />'~ t <br />.,:°. .. <br />Signed: <br />Corporate Secretary ar Equivalent <br />TowNCity/County Clerk <br />The foregoing instrument was aclmowledged before me this a?O~ day of rEt~2•vri-2Y _, 2~'~ , <br />by Dean H. Craft ~ Presides pI' suburban sand and Gravel Co. <br />r •3178q '~r~ r75. <br />d ~_`~ <br />~,_ r ~ <br />Notary Public <br />'fdb10~ `c, <br />~°;~•~Nd~~y My Commission expires: /O~/8/zco5 <br />SIGNATURES MUST BE IN BLUE INK <br />M:~edbveWa~W23CO1S.A4P (07/t7RW0) <br />