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-8- <br />• <br />Certiftcation: <br />As an authorized representative ofthe applicant, l hereby certify [hat the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) inexistence at the time <br />this application is filed, and located within 200 fee[ of the proposed affected area have been identified in this application <br />(Section 34-32.5-I 15(4)(e), C.R.S.). <br />2. No arining operation will be located on (ands where such operations are prohibited by Iaw <br />(Secflon 3432.5-I 15(4)(t), C.R.S.; <br />3. As the applicanUoperator, [ do not Gave any extractiorvexploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Ac! for the Extraction of Construction Materials <br />(Section 3432.5-120, C.R.S.) as determined through a Board finding. <br />4, I understand that statements in the application aze being made under penalty of perjtuy and that False statements <br />made herein aze punishable as a Class t misdemeanor pursuant to Section 18-8-503, C.R.S. <br />• <br />This form has Gem approved by the ~aed Load Redaaratioa Board pursuant to section 34-325-111,C.R.S, ofthe Colorado Laad <br />ReAama6on Actjor tke ErtrocYion ofConstructiaa Materials. Arry aherariaa or madiJieatiort ojthis form shall result in voiding any <br />permit issued on the ahered or modified form and subject the operator to cease and desist orders and tivll pmahies for operating <br />whhout a permit pursuant to sertton 34-325-113, C.R.S <br />Signed and dated this Ce day of Mr~ecH 2001 <br />LA/ZSE~ ~-.CI.,9ati0o l_l..C_ <br />ApplicanUOperator or Company Name <br />Signed: <br />If Corporation Attest (Seal) <br />Signed~_~ <br />Corporate Secretary or Equivalent <br />Title: <br />State of Cow¢Aa~ ) <br />ss. <br />County of TCb.no.s-r ) <br />TowrJCity,'County Clerk <br />The forego`i'ng instrurry~nt was acknowledged before me this _~_ day of ~~r1~(J/~~ _, <br />~, by ~~~hr ~ ( r4P11 as rn~.l~L~l~Q1/ of~L~Qy~--~>~~iIYL~G~O I ~. ~Lr, . <br />NpTARY <br />pUBLIC_ <br />M:Y~enxhe,c~nlwmd[Yw,u'oon ~ 12.doc (Apprmxd OSII I!?t105) <br />Commission expires: g~ d ~ <br />INK <br />