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-8- <br />Certitiestlon: <br />As an authorized representative of the applicant, I hereby cetifythat the operatiart described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanentman-rrtade structure(s) in existence at the tirtte <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 3432.5-1 IS(4xe), C.R.S.). <br />2. No mining operation will be located on lands where such operations are protu'bited by law <br />(Section 3432.5-t tS(4xf), C.RS.; <br />3. As the applicant/operator, I do not have any extractionlexptotation operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act far the Extraction of ConstnreHon Materials <br />(Section 3432.5-120, C.R.S.) as determined through a Board finding. <br />4. I u~erstand 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 pursuazrt to Section 18-8-503, C.RS. <br />Tdis fans has been approvsd by tht Afbved Load Reclaeradoa Board psrssaat ro sMioa 34-3T.5-771,C.RS, ojtht Colorado Laad <br />Retlamatloa Ad jorthe F,ztradioa ojCaastrncrioa bfattrlals..lapdteroflos arerodifltaflos afthisjorm shag ressh in voidtag arty <br />perm& hsstd oa tht ahered or mod{/led form aad wbjed dYe operator to tease asd desias orders and clop penahles jor operodsg <br />whhaut a permit parsaent to sedloa 3I 31.5-123, GR.S <br />Signed and dated this ~ sT day of ~b u e m h e ~° Z yv Lv , <br />~~ ~~l J. (>ctp~re~vt-4 <br />N •' N f <br />~/u.rh(~r/,,. J, ~C(G,dreGltl~ <br />ApplicanVOperator o; Con ;parry e <br />Sig ~r~ l~a~~ <br />Title: l l W yr e.r 5 <br />State of Ci"tl,.Cll~~n ) <br />ss. <br />County of ~ t_(~g(ZT ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/CitylCounty Clerk <br />The foregoing instrument was acknowledged before me this ~ ~7 day of ~~~V i=vt~ t'~~ , <br />_, bv~Q..: t z=t` J - ~ AU DBE-~YU l_T' as <br />A,.n ~Ae.P~A,eA J -GAuDiz>=Au~T <br />My Commission ~~~~ ~- <br />+~'' ~ •'~ •. 9 •, <br />SIGNATURES MUST BE [N BLUE INK ~'ty~^~ •, <br />M:mmran.Kn.,ramarannxaoo nz.doc !Approved OYllfl00S) ~ /~.: ~®TARY <br />~~ <br />t/~~ PU~~-~ OQQc <br />~~~ <br />