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- 7 - <br />Certification: <br />As as antkarized rive of the applicant' I hereby certify that the operation descarbed has ~ the mininnnn <br />regnir of the foIIowing t~s and ca~itioms: <br />1. To the best of my knowledge, all significant' valuable and permanentman-made structure(s) inexistence at the time <br />this application is filed, and located within 200 few of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. No mining opeaafia~n w7l be located elands where sudt operations are prohibited by law (Section <br />34-32.5-115(4)(fJ, CRS.; <br />3. As the applipnt/operator, I do n~ have a~ extraction/eaq~loration opeaations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act far the Extraction of Construction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Board finding. <br />4. I understand chat staY~ts in the application are being made miner penalty of perjury and that false statemems <br />made heap are punishable as a Class I misdemeanarparsoant to Section 18-8-503, CRS. <br />Signed and dated this ~ ~~~ day of _~~~. ~~,~- ~c5 ~ ~ ^ <br />~1 G~-cu..r ('o .~~.a-~~ If Ccaporation Attest (Seal) ' ~ ^ <br />'App]icaudOperatorarCompa~Name .~, <br /> <br />~I <br />Signed: t 1 In e a ~~ r,,.,. ~ C~, <br />Corporate Secretary or Equivalent <br />Titre: Baca County Commissioner District 2 Town/City/CotmtyClerk <br />State of Ce-la->:,~ <br />ss <br />County of Baca ~ f <br />The foregoing insutmtent. was aclmowledged before me this _~~ day of 'S , ~~, <br />by A;ll Wr;ght as Commissioner of Baca County District 2 <br />'/.. <br />~_. ~ +- ~/ <br />_ `~ ;- _~~ Notary blic <br />y~ ^ ~ ~ ^ . , \ , My Commission espires: - -~~ <br />SIGNATURES MUST BE IN BLUE INIi <br />MV®`a6smhafu~lCaosne~n 1t2doc (10/]r/]L01) <br />