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<br />- ~ - <br />Certification: <br /> <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 />I . To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-1 IS(4)(fJ, 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 (Section <br />34-32.5-120, C.R.S.) as determined through a Board fording. <br />4. I understand 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 pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this 7 ~ day of Yh fl Y ¢~nT_. <br />GRASSER CONSTRUCTION,INC. <br />ApplicanUOperator or Company Name <br />Signed: <br />Title: President <br />State of (AO~p,P~~ D ) <br />ss <br />County offCi'~ (`R~Jo~ ) <br />If Corporation Attest (S?al) _ ' <br />/ / ._ ; <br />Sign 4/ <br />rporate Secretary or Equivalent <br />Town/CitylCounry Clerk <br />The foregoing instrument was acknowledged before me this ~ ~~L day of D O , <br />bYl~NI ~ L L ~,C'-~SJ'e,e as QrP.t ~ ho.~ ~ of 6'h/f a~i.rY-Quc~-rc,d, -z`.~'. <br />~,PO ~ C /1/l,~ <br />Notary Public <br />My Commission expires: ~~ g-ol~O.~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:U4MSHARElVSFpRM5~38I7Q713.MP OLIQ"19 <br />