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~- <br />-~- <br />Certification: <br />As an authorized repcesentative of the applicant, f hereby cenity that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />I. To the best of my knowledge, afl sienificant, valuable and permanent man-made structures} in exis[ence 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 3d-32.5-I IS(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />3d-32.5-I l5(4)(f), C.R.S.; <br />3. As the applicant/opera[or, 1 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 />3d-32.5-120, C.R.S.) as determined through a Board fmding. <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 ~ day of /y,9/2 G" /, ~O <br />/• /t • C/ti ~ERJ~irt'i.S ES <br />Applicant/Operator or Company Name <br />Signed: <br />Title: ~ft~. Ij~ i:~ o-f2 <br />State of /n.P~1 _ _) <br />ss <br />County of ~P(/~.- ) <br />If Corporation Attest (Seal) <br />Signed: ~ <br />Corporate Sege or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ro / S~ day of M,4.P~,~/ <br />by ~^ V~rl /'~ ~. ~~[~P aS ~r'n /`1Gno2Pr _ Of f~/~ ~n /ran f.trT ~a/~_ <br />""~Ip{Olllp ` <br />~ ~O <br />~~~~01O n <br />~`~~a'af r~~~r Notary Public <br />~LIVl~~~oJ My Commission expires <br />IN BLUE INK <br />~1:\W NSHAAFVSFORM5~21:]C0131~PP OLIO/99 <br />