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<br /> <br />Certification: <br /> <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, valtlt and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of 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 on lands where such operations are prohibited by law (Section 3432.5-1 IS(4)(f), <br />C.RS.; <br />3. As the applicant/operator, I donor 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 Conswction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Boazd finding. <br />4. 1 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 dates this a^~ day oC afb, <br />l~M Y~gr,vt.u~ ~or ~ e ~~ ~~r~ner <br />Applicant/`Operator or Company Name <br />ty qn~~~~ <br />Signed: r ~N7'Yxr'~ <br />nn ~~~"`' ~cu'v-"`~ <br />Title: Gnu C/rLA1t,C <br />State of Cd ~ <br />ss <br />County of m ~7SQ . _) <br />If Corporation Attest (Seal) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ day of a~ ,, , <br />by RC ~ `as ~~, of ~ mPr ~t~nS`Ma['~;y, <br />iv~ef <br />t QUBL/~+ Notary Publ~ v <br />'•. <br />.~ ~ ~~~.o <br />51`P~y,P~ ~~ My Commission expires: ID-~~-~3 <br />:~ <br />:O <br />,~ ~`~ SIGNATURES MUST BE IN BLUE INK <br />Signed: <br />