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• • RECEIVED <br />JUL 172000 <br />- ~ - <br />Division of Minerals & Geology <br />Certification: <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 />1. 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 are prohibited by law (Section <br />34-32.5-I15(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 Cclorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board fmding. <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 Zg day of 2AbC) <br />< ~_ Its L:l~(l,~ r.r,~ ri^ r-~. If Corporation Attest (Seal) <br />Aerator or Company Name U <br />Signed: ~G'y/29l/,y! t, N,~f/, r ~ <br />~igned: L~=~~CS~t~~tSDCt~ ~,~ <br />s1 Corporate Secretary or Equivalent <br />Title: Yl/~1/l~A~~ ~;1f/.Q'C f i O.~ /%L<<-EJ~M/~~% <br />Town/City/County Clerk <br />State of l~-6 ~-~-~-(7 ) <br />IQ , ~ ) ss <br />County of I"~6-U,Jt~.-t-TtJ ) <br />The,f~or~ego~i~ng"in~strum/~ent wasacknowledged before me this ~ day of ¢- ~ Uy , <br />bY„1 ~~ ^-wt`-.'IC_.E-c-t~-e- as ~~u~ ~.~.u~ <br />Notary Public <br />My Commission <br />s~~.,vl <br />Z`_~ O F <br />SIGNATURES MUST BE IN BLUE INK <br />0 <br />M:N9NSHARFVSFORMSVBIlCO17.APP OLIO/99 <br />