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r <br /> certification: <br /> As an authorized representative of the applicant, I hereby certify that the operation <br /> described has met the minimum requirements of the following terms and conditions: <br /> 1. To the best of my knowledge, all significant, valuable and permanent man-made <br /> structure(s) in existence at the time this application is filed, and located within 200 <br /> feet of the proposed affected area have been identified in this application (Section 34- <br /> 32.5-115(4) (e) , C.R.S. ) . <br /> 2. No mining operation will be located on lands where such operations are prohibited by <br /> law (Section 34-32 .5-115(4) (f) , C.R.S. ; <br /> 3. As the applicant/operator, I do not have any extraction/exploration operations in the <br /> State of Colorado currently in violation of the provisions of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials (section 34-32.5-120, C.R.S.) <br /> as determined through a Board finding. <br /> 4. I understand that statements in the application are being made under penalty of <br /> perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br /> pursuant to Section 18-8-503, C.R.S. <br /> Signed and dated this Sleb day of 1/LJNe /999 -` <br /> Jake Kauffman $ Son, Inc. If corporation Attest (se��l)•.-_ <br /> ApplicanttlOperator or Company Name <br /> Signed: Signed: <br /> &rporq Se ry or Equivalent <br /> Title:,.. /R�C-.S r�e;117�" Town/City/County Clerk <br /> State of - Y ) <br /> //� ss <br /> County of <br /> The foregoing instrument was acknowledged before me this J� day of <br /> by __aAN,' 4c,, FFmAJ as �RESiJE{JT of TRKF �R�+f�ryilJ s �J� Scic. <br /> Notary Public My Commission expires: U•311Y�02000 <br /> SIONATURES MOST BE IN BLUR INK <br /> 06/26/97 2823FCO.112 <br />