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~,P^- ~r~ <br />,. <br />RECEIVED <br />Certification: ~EC Q 8 <br />2~~~ <br />As an authorized representative of the applicant, t hereby terrify [hat the operation d65c{ibed has met the minimum requirements <br />of the following terms and conditions: [nsion of Minerals and Geology <br />1. To the best of my Imowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 fee[ of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />Z. No mining operation will be located oa lands where such operations are prohibited by law (Section 3432.5-115(4)(f), <br />C.RS.; <br />3. As the applicant/operator, I do not 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 Construction Materials (Section <br />34-32.5-120, C.R.S.) as deteanined through a Boazd finding. <br />4. I understand that stazements in the application are being made under penalty of perjury and thaz false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />~ ,/ <br />Signed and date$ this . h[~y day of nN2 e ~m 6e.P ~OOd <br />H ~ /~ S l DNE C'.,, ANC <br />~ApplicantfOperator or Company Name <br />Signed: ~„~C~e~~ <br />Title: Cn - n Lt1 NC. ~ . <br />State of <br />County of ~~~~ ~ jss <br />Towo/City/County Clerk <br />The foregoing rostrum//e t was aclmowledged before a this Y~c--day of , <br />by T 1 as / - 1 of tr' ~ , <br />If Corporation Attest (Seal) <br />Signed: <br />Co orate Secretary or Equivalent <br />N Public <br />My Commission expires: ~' _ <br />SIGNATURES ivt[IST BE IN BLUE INK <br />