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<br />-~- <br /> <br />tification: <br />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)le), 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 applicantloperator, 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 39-32.5-120, 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 C/ day of ~1 u-S % C7~Q <br />t4ario Bassi and Josephine Bassi <br />Ap licant/Opera or or Company Name <br />aMlO n ~ ~ <br />~ned :.y~ . I~a~ <br />Title: ()WnerS <br />If Corporation Attest (Seal) <br />Signed: <br />State of Colorado ) <br />ss <br />county of Rio Grande ) <br />Corporate Secretary cr Equivalent <br />Town/Cit}•/County Clerk <br />The foregoing instrumenft was acknowledged before me this ~ day of ~ ~~ <br />by ~\.P2~b I,I~S i nlb~cl as ~W ~~hS of <br />~J~SE~1~ ~ Ne ~~ri ~t ,.~ ~ r ~ //~ / <br />Not~y AI1b11c <br />My Commission expires: U ~~-~ ~- ~~2- <br />SIGNATQRES MIIST BE IN BLIIE INK <br />06/26/97 2823FC0.112 <br />..,yfa1.... .,~.r... ~. <br />