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. ..: <br />_;_ 9F <br />~'~, <br />o~. <br />Certification: ~~~~ 4 / ~ ~ <br />As an authorized representative of the applicant, I hereby certify that tfie operation described hasfinet~t~j~inimu~ <br />requirements of the following terms and conditions: o'soodc% <br />I. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence atg~(ie 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-; 2.5-I IS(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />3d-32.5-I 1514)(f), C.R.S.; <br />3. As the applicanVoperator, I do not have any extraction exploration operations in the State of Colorado currently in <br />violation of Lie provisions of the Colorado Land Reclamation Act far the Extraction of Construction blatarials (Section <br />34-325-120, C.R.S.) as determined Chrough a Board finding. <br />4. [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 I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this -% ' <br />Colorado Lime Company <br />day of J _ ~ , , ~ -.>,_> <br />ApplicanUOpatator pf Company Name <br />Signed: t l~//•~i /J'//.~/' ~ [~~i <br />Title: Vice President - Manufacturing <br />State of / C ~ ~ ' <br />/ ) ss <br />County of ~ ti ) <br />The Foregoing instrument was acknowledged before me this _ <br />If Corporation Attest (Seal) <br />Signed: '~~i~l ~- <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />J <br />~ ' ~ day of ..J ~ .~ '3°,'° , <br />i <br />. ~ ~ l 1, , -_ ., <br />®LfL'ZA C. MAY!!i <br />Nouurrwrveoraarrrzy Notary Publi <br />• APRIL 1f, 2004 <br />My Commission expires: ~~~~' I / `' .~r~ ~ <br />SIGNATURES MUST BE IN BLUE INK <br />M.6NIMSHMEIVSFORMS~381JC01?..WP ovia~v <br />