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- RECEIVED <br /> Certification: SER 12 <br /> As an authorized representative of the applicant,I hereby certify that the operation described has44 W*tf MhowhAPHkownents <br /> of the following terms and conditions: <br /> 1. To the best of my knowledge,all significant,valuable and permanent mart-made structure(s)in existence at the time this <br /> application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br /> (Section 34-32.5-115(4)(e),C.RS.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32.5-115(4)(q, <br /> C.RS.; <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.RS.)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 made <br /> herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.RS. <br /> Signed and dated this 1 day of C&yl Cf-� P-c'G' <br /> Western Mobile Northern, Inc. <br /> If Corporation Attest(Seal) <br /> Applicant/Operator or CompanyName <br /> Signed:P� z�uczX- JaLGju�� Signed: <br /> Corpor a Secretary or Equivalent <br /> Title: Vice President Town/City/County Clerk <br /> State of Colorado <br /> )ss <br /> County of_ Denver 1 <br /> The foregoing instrument was acknowledged before me this 7rA- day of <br /> by Michael D. Sheahan as Vice President of 7estern Mobile Northern, Snc. <br /> LINDA S. BACH j <br /> NOTARY PUBLIC <br /> STATE OF COLORADO otary Public <br /> My Commission Expires 08/17/2004 <br /> My Commission expires: 7 (�vp <br /> SIGNATURES MUST BE IN BLUE INK <br /> i <br />