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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the Gme <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.R.SJ. <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-115(4)(t), C.R.S.; <br />3. As the applicandoperator, 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 determined through a Boazd fmding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this c ~ S~' day of YY1 t4~ o~J°~ <br />Applicant/Operator or Company Name <br />Signed: <br />If Corporation Attest (Seal) <br />Signed: <br />Title: /t1~.n-.ca.a i~v~i ~~rTNei <br />Sta[eof Cot_n2-f'~,Jd ) <br />~`~~ ss <br />County of ~'~ao(rCi tEl ~ ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this a ~ Si day of ~ ~`1 , d~ ~' <br />by -iohl4lT4fln j~• rllE asMt4PlAGinG (~19R-t11~°4 of r~1RfiRUrnwurzl :trl LC~i~ <br /> <br />rAy <br />Notary Public N t,.o <br />q~~ RB O O, <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />iomioi <br />