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-~- <br />Certification: <br />As as authorized repres~tative of the applicant, I hereby certify that the operation descalbed has met the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and pem2anentman-made structure(s) in existence 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 on lands where such operations are prohibited by law (Secdion <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicanVoperator, I donot have a~ exlraction/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 determined through a Board Ending. <br />4. I lmd~stand tbai statements in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section IS-&503, C.RS. <br />Signed and dated this 2 Z~ J /dray of J ~ ~~' 7~3 <br />t~cih 1 le l .~nc.t~e:l ~_ t--C~Vw~at~ti~ <br />Applicant/Operator ~ Cam~pa~~Nan~~O~~ <br />v /n~ <br />Title: U~ (~ GQ(~Ga. <br />State of Lv l ~C7~d c7 ) <br />ss <br />Counh~ of ~ ~ ~(~'~ n ) <br />If Corporation Attest (Seal) <br />_~ <br />Signed: ~~ <br />to Secretary or Equivalent <br />Town/City/Crnmty Clerk <br />The foregoing inctn.me•~! was aclmowledged before me this ~ rid day of ~_, <br />by ~_)PrriA1~ Cf'}i rp as U1~ ~4P~ides'I-F- of `Jf1c. ~ r~Cp <br />.` ' J A. C /~ ``~Fsj <br />,`: ~,,. .... 3 6 <br />,- ..:.. ..... o~~c <br />,``~.~CTARY ~ . <br />'• ° Notary Public <br />~~,,'~ 3c cpVO``e,~ My Commission expires: 9/a~lo~ <br />SIGNATURES MUST BE IN BLUE INK <br />M~`ahcnlv~lCumymtipp ll2.doc {10/15!2001) <br />