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7 - <br /> Certification: <br /> As an authorized representative of the applicant, I hereby certify that the operation <br /> described has met the minimum requirements of the following terms and conditions: <br /> 1. To the best of my knowledge, all significant, valuable and permanent man-made <br /> structure(s) in existence at the time this application is filed, and located within 200 <br /> feet of the proposed affected area have been identified in this application (Section 34- <br /> 32 .5-115 (4) (e) , C.R.S. ) . <br /> j 2. No mining operation will be located on lands where such operations are prohibited by <br /> law (Section 34-32 .5-115 (4) (f) , C.R.S. ; <br /> 3. As the applicant/operator, I do not have any extraction/exploration operations in the <br /> State of Colorado currently in violation of the provisions of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S. ) <br /> as determined through a Board finding. <br /> 4. I understand that statements in the application are being made under penalty of <br /> perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br /> pursuant to Section 18-8-503, C.R.S. <br /> Signed and dated this r_ day of <br /> Moffat County Road Department If corporation Attest (seal) <br /> Applicant/Operator or C mpany Name <br /> Signed: 1A-1 Signed <br /> Denn S Jo es Corporate Secretary or Equivalent <br /> Title: Road )Super 'so Town/City/County Clerk <br /> State of ( /'i/F9?i�e4;) ) <br /> ss <br /> County of ) <br /> The foregoing instrument was acknowledged before me this Zad day of 99 ), <br /> by A/Onllli0 f'1 , 62012 as R(Y"ir� ��J�YL)i�n� of - ,--� <br /> �tnh.r i� 'A//fm,� <br /> Notary Public <br /> My Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br /> 06/26/97 2823FCO.112 <br />