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~i <br />-~- <br />Certification: <br /> <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 />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 I5(4)(e), C.R.S.). <br />2. No mining opetation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-I I5(4)(f), C.R.S.; <br />3. As the applicant/operator, I 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 fording. <br />4. I understand that statements in the application aze 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 ~ r ~ ~ 00 <br />Mullett's Excavating, LLC <br />Applicant/Operator orCompany Name <br />Signed: ~//~«?iiC~LT/ <br />My Mullett <br />Title: <br />Owner <br />State of Colorado ) <br />ss <br />County of Custer ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ day of ~~~ , <br />by Myron Mullett as Owner of N,ul ett's r;xcavating, LLC <br />MR ~Gl ~~V ~/"~~ <br />~Qy /\ <br />~Ry~~ ~ Notary Public <br />"~' ~ 7Ylarc4, t~ 2tx12. <br />My Commission expires: ~ <br />~OUBUG r ~,~ <br />IN BLUE INK <br />M:U9MSHARE\VSFORM5~2823CUI2APP 07/10/99 -~'~~~~~~~~- <br />My CortvrYlsbn F~Irts wrcn 16, ~ <br />