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-, <br />Certification: <br />As an authorized tepreseatative of the applicant, I hereby certify that the operation described has tuet the minimum requirements <br />of the following terms and conditions: <br />!. To the best of my lmowledge, all significant, valuable and permanent man-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 locatrd an lands where such operations are prohibited by law (Section 3432.5-115(4)(f), <br />C.RS.; <br />3. As the applicantloperator, I donot have any extractiodexploration 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 tmderstand that statements in the application are being made under penalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanorpursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~ ~J~ day of Mol`r'G~1 Zc~c~ ] <br />~c~C St'a~ l~c,~t~a~ La-C <br />Appli Operator or Company Name <br />Sigaed: <br />Title: Manc~CS,PX <br />If Corporation Attest (Seal) <br />Signed: <br />State of 5ou}~1 1~~5}e 1 <br />ss <br />County of P~ ~ t ~Q~? )) <br />Corporate Secretary or Equivalent <br />Town/City/County Cleik <br />The foregoing instrument was aclmowledged before me this ~ 3~` day of ~Yt~ 1 ZOO 1 , <br />by At-uol 8t^~~rn(eu as l~,a~®P .v'r of (rbu~ ~{m{F.5 4~cA '~a}CS LLC, <br /> <br />_,,._,__ <br />y NATHARt A, gA~Tt7i~f v., <br />~1 NOTARY PU9LiC ~;' Notary blic <br />~ State of Soutn Dakota H, <br />My Commission expires: 1~5~ 2L'~~S <br />SIGNATURES MUST BE IN BLUE INK <br />