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- 7 - <br />Certification: <br />As an autliariz.~ representative of the applicant,l hereby certify that the operation described has met the munimurn <br />requsements of the following tams and conditions: <br />1. ?o tae best of my l:nrn~ledge, all significant, vallzabla and permanent man-made struci~:re(s) in existence at the time <br />this application is filed, and Located. mixhin 200 feel of the proposed affected azea hate bean identified in this application <br />(Section 34-32.5-I15(4)(e), C.RS.). <br />2. No mining operation ~;'3'~f be lo:,atrd ~ lands who;, s'~ch operations are frohibit:;d b}° law (Se~,~ton <br />3~-~ 25-215(4}{f), C.RS-; <br />3. As the applicanUopaator, T donot have auy extractionJexploration operations in the State of Colorado currealtly m <br />violation ofthe provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />3=. -32.5-120, C.RS.) as determined through a Board 5ndicg. <br />4. I understand that statem~ts in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 mi~eanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this 2J! "' day of ~ ~ t (' ~'O <br />ApplicanUC+pexaiar err Company Name <br />Signed:/GJrG'~`r ~ / / /~Lt~~ <br />v nn <br />Title: tlL[.JniE.e. <br />If Corporation Attest. (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/Couary Clerk <br />Stage of 1~7w-~LA-tom 1 <br />ss <br />County of ~jh~~PS ~ <br />>4 ~1~ <br />The foregoing inslrumeaN was acimowledged before me this ~ day of /`N'/~- ~ `~ , <br />by ~6~4-i Y'-. £ai?~ 1s' as ~•.F.c. of s ._ ~ sr Pr <br />Notary Public <br />My Commissioa expires: P'~u l4 <br />SIGNATURES MUST BE IN BLUE IlVK <br />M1t~kLankaforms~Camhuaion 112da (1Ni3/Z~1) <br />