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7- <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 34-32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(1), C.RS.; <br />3. As the applicant/operator, I do not have auy 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 <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~ day of ~tw.,,.y z ~ a <br />,.~,. ..~ <br />~~ n <br />~r1~Go ING If Corporation~ttest•i <br />ApplicandOperator or Company Name _ <br />QQ i -: <br />+~ '>~ <br />.C.-0~ ; . <br />Signed: ~ -0ta Si~~: <br />!' r Q-~ _R <br />Title: ~c~ss~ ~o ~ ~ - .'PQwn <br />State of C cue-c~-~ ) <br />ss. <br />County of `J.~~ty ) <br />~.~ <br />or Equivalent <br />unri Clerk <br />The foregoing instrument was acknowledged before me this ~ day of _, boo by <br />v <br />~n _J to <br />Notary Public ~ z J~ C <br />., Q <br />~.,,- t . <br />• My Commission expires: '~~F~1C~J 5/ <br />SIGNATURES MUST BE IN BLUE INK <br />M:1vtinWureWCrmms\COmw~tion ll2.doc (10/152001) <br />