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-~- <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 lmowledge, 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 azea have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S J. <br />2. No mining operation will be located on lands where such operations aze prohibited bylaw (Section <br />34-32.5-115(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 Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Boazd fmding. <br />4. I understand that statements in the application aze 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 ~bY'UGt^/ 21,Y~ <br />1 <br />r7Dfld~ ~IQ ~'LIeS C_t,O,~Ff1G~ <br />ApplicanUOperator or Company Name <br />Signed\U-,L_~~ V~ <br />Title: ~r`~3ic~P11t <br />State of l.o%ra~~n ) <br />ss <br />County of ~GY/gu~ ) <br />The foregoing instrument was aclmowledged bef"o~re me this s~ day of ~GJI'7/Cc r ~ ,200 5/, <br />by ~vi 7el I.1 . ~ ~, r ~- as 1 ~^e S ~cler ~- of ~~i D ~Sr~er,,. Qhrr ~v ~Qrz.~ <br />~'~~9 <br />~~ <br />~~ ~ <br />;N <br />S <br />Notary Public <br />~ ~~ <br />~Pr ~ <br />~ My Commission expires: ~-~~- O <br />MPion <br />SIGNATURES MUST BE IN BLUE INK <br />M:V.IW~BDC~MINPORMS~2833COI2.APP 10/17/01 <br />