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• i <br />Certification: <br />~l <br />- 7 - <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 34-32.5-115(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-I 15(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction exploration operations in the State of Colorado cun•ently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />34-32.5-] 20, C.R.S.) as determined through a Board finding. <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 dt/dy~rt~~X ~ O 1. <br />A.o.ti coN'~cr~~ A~NG7 <br />~~ ~ APP <br />Signe <br />Title: <br />Stateof~6l~C~fQCj~ ) <br />ss <br />County of CCU YYQ1 t~()Il ) <br />Signed: <br />Corporate Secretary or Equivalent , <br />Town/City/County Clerk <br />The floLregoing instrument was acknowledged before me this ___L-~__ day of Q//t°%]] ~Y' . ~~ , <br />by ~iCd t C O'~Ppl as ~1~~1~.1~.~_of ~ ~117C'CaC'(C7 <br />Nota <br />PtlBL1~ <br />expires: ~,{~ rX.~, a~ <br />SIGNATURES MiIST BE IN BLUE INK <br />~~/7/tr ~j ~ ~ ~f Corporation Attest (seaq <br />M:V.QMSl1ARElVSFORMS~2ffiiC012.APP ovia9s <br />