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Jul 13 04 10:20a <br />Randolph W. Starr <br />_~. <br />Cert~cation: <br />970 669 3841 <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the foUowiag terms and conditions: <br />p.6 <br />I . To the best of my lmowledge, al I significant, valuable and pe[manentman-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(4xe), C.RS.). <br />2. No mining operaion wit! be located on lands w~cre such operations are prohibited bylaw (Section <br />34-32.5-115(4xf), CRS.; <br />3. As the applicant/opcrator, I donothave s~ extraction/exploratron operations in the State of Colorado currently in <br />violation of the pmvisions 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 finding. <br />4. I understand that 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 18-8-503, C.RS. <br />'-~ - <br />Signed and dated this day of ~~t-`! .,{~ ~` ~l <br />fit ;.; !, ,iJ.' ~,_~ ~ 1~... i '.~ ~° <br />App(icanN(~erator or Company Name ~, . <br />Signed: <br />~~ <br />Title: 1 ~~_ _ <br />T -- <br />'' <br />State of <br />ss. <br />County of 1 <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was aalmowledged before me this day of ~F[J t-Y ~~ Sr . by <br />!i r'° , <br />~Cf,'.."~.. t. ^. 1 d.A/slr:~c..... ~, as _ ~t~(:.-".•?c?a~2..n~. Of ~°~.%{1-`(~".ks7' ~. ._x.•,•'. ~'~ ~*4-' L~'),tTf;'t~L'tn <br />'T ~ ~. <br />Notary Public <br />If Corporation Attest {Seal) <br />Signed: <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />M:4nin~stw<\vsrmm~~Cmmuman ll3dx (IO/I5ft0Ul) <br />