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~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimtun <br />requirements of the following temu 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 ffied, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4xe), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicant/operator, I do not haveany 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.RS.) as determined through a Board finding. <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 I misdemeanor pursuant to Section 18-8-503, C.RS. <br />T~{ <br />Signed and dated this 1 °'7 '"--' day of . J3 uGU s'r' . ~ o o i-./ . <br />- .1..` T <br />ApplicanUOperator or Company ame <br />J <br />Signed: <br />~Q~.-u~-~eS~n-~ <br />C H A•SR M Ate/, <br />Title:~~nlT CrJ. COMM~SSrah/ E12.5 <br />State of ~ a t- o R a ~ a I <br />ss. <br />County of ~~Enr'T I <br />Corporate Secretary or Equivalent <br />'County Clerk <br />.T/~ <br />The foregoing instrument was acknowledged before me this 17 day of ~ u ~ u s ~- .2 n a i-/ by <br />-.-.pv,,t'scn,cE S~niA- as cHprRnnan/ of?ieur GO. Coi,~,nnx<S~eniaQcs. <br />J ~~ ~~ <br />Notary Pu lic -=/~ <br />If Corporation Attest (Seal) <br />`Signed: ~~ 9...~ ~~ <br />My Commission expires: O .+ - r 9 -.,~ on C <br />SIGNATURES MUST BE IN BLUE INK <br />Mtrmnlshme~.rsfams`R:rmm~wtiw i tza« (iatsrmo~> <br />3 <br />