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<br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of rtry knowledge, all signi£cant, valuable and permanent man-made structure(s) m existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea 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 3432.5-115(4)(f), <br />C.RS.; <br />3. As the applicant/opera[or, 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 Ext*actior. of Cerstruction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Board 5nding. <br />4. [understand 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 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~ day of ~1.~ us-E , <br />/Zy~' ~S~k,-1e5 ~A.,--~rn crs <br />ApphcandOperator orCompany Name <br />Signed: <br />Title: _~~,J{1 <br />State of ~~pr4G~0 ) <br />\\ 11 rr ) ss <br />County of ~1eFkersorl ) <br />ff Corporation Attest (Seal) <br />Corporate Secretary or Equivalent <br />Town/Ciry/County Clerk <br />The foregoing imstrttment was acknowledged before me this ~h day of A-t-,oust o?Gb 1 , <br />by ~ye ~hul ~-e'~ny~ as ~rP~:~~eri'~- of (2u~ ESFa1f5 r~rln r5 <br />•5t <br />5 <br />Signed: <br />KATHY JANflES ~ NOBS' ~~ (/ °~~rxL~ <br />0 <br />~A„_ ,,:~~~~ My Commission exprre : /071a~l~o/ <br />SIGNATURES MUST BE IN BLUE INK <br />