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-~- <br />Certfication: <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 permanentman-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.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I donot haveany extraction/exploration operations in the State ofColorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Board fording. <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.R.S. <br />17r6 jotrrr has been approved by tke Mined Land Reehmratlar Board parsaan! to section 34-325-I12,C RS, ojtke Calarodo Land <br />Reclamation Ad ja tke Fa7ractton ojConstrndion Marerrds Any alteration ormodifuwtion ojtkir jorm skoQmah m voiding any <br />permit &saed on the altered or modfJfed jam and sttb, fed tke optrator to ceau and desttiT orders and civR penaUies jor operating <br />rvithoat a pnmit patsaaU to sectiar 3h32-123, C.RS <br />Signed and dated this /S-H.. day of /1.ea_: L . 2 005 <br />~.otLl-y~!~x.cnaaa-S.~~ ~uc IfCorpomtionAttest(Seal) <br />ApplicantJOperator or Com Name <br />Signed: ~° ~-- Signed: ~~...a-•.~:-~V1era.ena,:,.:, i R~ <br />Corporate Secretary or Equivalent <br />Title: ~FL85'~ tEa-E Town/City/County Clerk <br />State of eG~.eQ~d,o ) <br />ss. <br />County of ~.,wrt:.t-~Ltz 1 <br />The foregoing instrumentwas acknowledged before me this (5-1i.. day of {~np ;1- . ',IoC$ <br />_, by 'QSelr.wed Cau.!`teat as ~2,; std -ak ofCir~~•\ ~ ~ ••,~ekr. <br />a ~,, Notary Public <br />,, ..F2 <br />'o;NOTARy:< <br />• ----- ~ = My Commission expires: u AO AOOie <br />%9 ••p • QP~o` SIGNATURES MUST BE IN BLUE INK <br />,'i~~ ~~" ~~••••• x``712 d«(W/28/2004) <br />