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-~- <br />Certification <br />As an authorized representative of the applicant. 1 hereby certifi~ that the operation described has met the minimum requirements <br />of the Collo~~ing terms and conditions: <br />I. To the best of my knowledge, all significant, valuable and permanent man-made structwe(s) in existence at the time this <br />application is filed. and located ~.ithin 200 fee[ of the proposed affected area have been identified in this application <br />(Section 34-32.5-] 1~(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited b_v law (Section 34-325-1 li(4)(Q, <br />C.RS.; <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.RS.) as determined through a Board fmding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ____~_ day of ~ P ul`~ (' tt•~ 4.` e (r , r~ OGI L~ <br />~~ ~t w-' ~L~ ~~, l-7i/til.l ~P.Li ~ ~,Cl.'1~. ~ ~ ~~ - If Corporation Attest (Seal) <br />ApplicanUOperator or Company Name <br />Signed: ~L ~CI~ ~1'~LG~ ~,fiy~ <br />Title: ~~ ~(-L't-twit <br />Signed' ~~l_'h-~-~- ~"`~n.,~ c. ~ <br />Corporate Secretary or Equivalent <br />Town/Ci[y/Count}' Clerk <br />Stateof_ IA~aRdo~ ) <br />ss <br />County' of ~ d, 6 Q, d ) <br />The fore~goin instrument was aclaowledged before me this ~l1 day o[ J ..~~]~.t- ~.~,D~U <br />by L~• ~-~; ~~~t.SjCi~l as ~2ESIt~r~,.~t: ofd G t~.tski+tl Co vs7~~.ril~~.'C.[~, <br />• ,.,. ~ <br />• No arv Pubiic <br />My Commission expires: I a - d ~ J ~Cb .~. <br />•` SIGNATURES MUST BE IN BLUE IN'IC <br />M:~mm`s6nch~rmmA2727C012APP (07/I7iI000) <br />