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~. • i III IIIIIIIIIIIIIIII • m2°~' ~'3 <br />RECE{VED <br />' DEC 2 1 2001 <br />Certification: <br />Givision of Minerals and GealoBY <br />As an authorized representative of the applicant, [hereby certify that the operation described has met the minimum <br />requirements of the foViowing 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-I IS(4)(e), C.R.SJ. <br />Z. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-I 15(4)(f), C.R.S.; <br />3. As the applicanUoperator, I do not have any extraction exploration operations in the State of Colorado cun•ently in <br />violation of the provisions of the Colorado Land Reclamation Act for [he Extraction of Construction Materials (Section <br />34-32.5-I ZQ C.R.S.) as determined through a Boazd finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~ day of d(~y~Yj'f3FX .Zc~ O /. <br />Q~y1FY~lCAN CoN~IIF.~ RN/~ s~?f'1/ti ~f ~ `)'Corporation Attest (Seap <br />ApplicantlOperator orGame <br />Signed: !'f~ ,i <br />RoE•~-T" <br />Signed: <br />Title: <br />Siate of ~,Q~~nf QCji~ <br />Corporate Secretary or Equivalent , <br />Town/City/County Clerk <br />ss <br />County of Gu y~~ ~~c~n ) g <br />The foregoing instrument was acknowledged before me this ~ day of ~©//z°/r1 hPV . o?~, <br />y ~ ~e~~~ per; ~ e.~-k ~rnev-<<c~~ ~ f~r~-~-°~~ <br />Nota <br />jDVBL\~L <br />expires: /~'({7 r~~J, ~~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:~WNSHMEIV$FORTiS282JC012.APP 07/10199 <br />