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<br />-~- <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 structures} in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.SJ. <br />2. No mining operafion will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.R.S.; <br />3. As the applicanUoperator, 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 (Secfon <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 Secflon 18-8-503, C.R.S. <br />Signed and dated this ~_ day of ~r y G y S ~ ~ ~ ~ ~, <br />eifar Cnna nrn inn <br />ApplicanUOperator or Company Name <br />Signed: S~ <br />Jerald A. Seifer <br />Ti[!e: Sole Propreitor <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />State of ~JLoRltl~ o ) <br />ss <br />County of Cct~i 0t2 ) <br />Town/City/County Clerk <br />The fo\regoing in~s/trunnment was nacknowledged before me this ~ ` ~ (1 day of ,-t w S I 200 ? <br />by JP.2hLol /I-• S~%1-ea,~ as ~7~vQ¢,~ (Lei ib2 of _ P. ~a.ei L1~NC,i 2uci id'v <br />.,., <br />Z ~ ~ w P:. <br />y_ h <br />•.j¢Z yf <br />r .~'~~~~ <br />N tary Public ' <br />My Commission expires: 1 a'~ 1'~D~(o <br />SIGNATURES MUST BE IN BLUE INK <br />M:Vr1IN~BDCUIINPORMS12823CO]2APP 10/17/01 <br />