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C~ <br />-~- <br />Certification: <br />• <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 />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 ~ day of ~(1CGGinee/[ /997 <br />II/~"l~I~l L'StSa.~Tt/ ~AO ~X~Oi <br />Applicant/Operato or Company Name <br />Signed: ~c.. <. A <br />r cc <br />Title: CAA ~)i1a <.e e/~SmR <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of C -e°IJ <br />~ ss <br />County of ~JfFFAT ) <br />The foregoing instrument was acknowledged before me this.' day of ) ,~~~, <br />by . \ ~l-~. (lCltl~ C\ 1)(1C~ U as ~ ~ l) ~ S(Y~ o f ~ ~ ~ ~( n FYw ~ , ( !]~A~) <br />i' <br />i ~ <br />Notary Public 1 <br />My Commission expires: ~'~L--~~~ <br />SIGNATIIRES MAST BE IN BLIIS INK <br />06/26/9'7 2823FC0.112 <br />