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• <br />-~- <br />Certification: <br />As an authorized representative of the applicant, L 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 15(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-I I5(4)(f), C.R.S.: <br />3. As the applicant/operator, 1 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 finding. <br />4. I understand that statements in the application are 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 ~C,C3A~„V ~0 0 <br />~ffF~Jr [~~.vr.~ ~AO ~(X~J/JTT.~rP~/ <br />Applica~nt/O~perator or Company Name <br />Signed l~ ~ <br />Title: /~,CI ~~.9U/Sm/1 <br />State of t~~°R!!do ) <br />,,~// ) ss <br />County of //IvF.</lT ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate ary or Equivalent <br />TownlCity/County Clerk <br />The foregoing instrument was acknowledged befnore me this ~ f2'~ day of ~ b.r , <br />by warn;s R Jon/_s as Ro4A~ ~/»:Gf/~3~Y of %J'~~'F ~u..~f~/ <br />f ~~Y ~~~- <br />Notary Public <br />My Commission expires: o~$~a~Q <br />SIGNATURES MUST BE IN BLUE INK <br />M NUtl~SHARklVSFORM5~28:JC012.MP 01/10/9V <br />