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=~- <br /> <br />Certificatioa: <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.) <br />as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~! day of _~~. <br />i <br />yam, ~~e~~~~ L - C ~/llsr <br />A plican / perator oor Company Name ~ <br />Signed: 7~~c7~, ~~~c <br />Title: Ow n-e/" <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of l,;~i~Al-3O('~ ) <br />n// ) ss <br />County of Y~1i'_OS ) <br />The foregoing instrument was acknowledged before me this 1~ day of ~_, /99.Q, <br />by A1~KP1/ L. K~ellnPr as~)ner of ~.J-/. VCea~cr /YIiX <br />10(1 ~`/~ n \l <br />N tary Public <br />My Commission expires: ~'~'`/-o2pOD <br />SIGNATIIRES MAST BE IN BLIIE INK <br />06/26/97 2823FC0.112 <br />