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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 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-I I5(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-1 I5(4)(f), C.R.S.: <br />3. As the applicant operator, 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 />34-32.5-120, C.R.S.) as determined through a Board finding. <br />4. 1 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 3 /J f day of 3u^r~/• ,~(K/(J <br />or Company <br />Signed: <br />Title: /C~ SL~n x <br />State of (/Lr~ lD 2Ql'~~~ ) <br />/~~ I / ) ss <br />County of F/ /~ ) <br />/.moo ,.S'i~~ G <br />if Corporation Attest (Seal) <br />Signets-~tL•e ~~~ ~~na~i~. <br />Corporate Secret r Equivalent <br />Town/City/County Clerk <br />The foregoing instrument w acknowledged before me the .3 / 5 day of Q , ~, <br />by,~oberz-f(~a2/~e~sfPrz.as ~2c~~/deny'- of_/2,~2 ~PSf22~"n~~ <br />~Cio ~ir~L <br />L <br />(V ~'-t-~r ~ My Co12J31/2002xpir s <br />- -taeta~l;c 1~~ <br />My Commission expires: " '~ <br />SIGNATURES MUST BE IN BLUE INK <br />M'VALKSHARtIVSFORMS~38SJCOI7.MP 03/IQN9 <br />