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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has mel the minimum nogruratta~ts ~ <br />the following terms and catditions: <br />1. To the best ofmy knowledge, all significant, valuable and perman~t man-made stnceture(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected area have been identiSed in this application <br />(Suction 34-32.5-1 IS(4xe), C.RS.). <br />2. No mining operation will be located oo lards where such operations ate prohibited by law <br />(Section 34-32.5-115(4xf), C.RS.; <br />3. As the applicant/operator, I do not have arty extraction/exploration operations in the State of Colorado currently in <br />violation of tbe provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.RS.) as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor ptusuartt to Section 18-8-503, C.RS. <br />Tbia jorm has been apprard by Ike Maned Lund Redaarafion i?oord prrsaarK m stdion 34-31.5-112,GKS, ojdYe Co%rado Land <br />RedanraNon Ad jo- die Exbodton ojConaarudbn Maruiala. Any aEtaadfon or nrodificaaion ojr6itjorne obeli resaEt in vof~ng any <br />permit isarred on dte aCertd or nrodj/ledjarnr and aub, jecrdYe opeaMr ro ceoaeand deridordm and ctvi[paraEbesjorapsnong»ikara <br />a prrmit paraaaMto aediar 34-31.5-~13, CR.S <br />signed and dated this (~G{' day of c,? . hit o s . <br />If Corporation Attest (seep <br />Si ~ ~.~ ~ ~ <br />orporate~ or Equivalptt <br />Town/City/County Clerk <br />State of w/o <br />////// ) ss. <br />Courrtyof l~~.PS~ 1 <br />The fo~r^egoing inst/nJrment w/~ acknowledged before me this/ Z ~ day of ~-ems.-•h-/.~ , z Ov ~ <br />I))' ~wy /C/K~L'Q i^4 a$ /M t~d'+~ Of ~7n/y-~L`L~~ Z~~ <br />My Comaussion expires ~~ c~oD <br />SIGNATURES MUST BE IN BLUE INK <br />x.+:~w.~~m~c ux.a~ (appmvea osn tnoos> <br />~P~dyo 6~~/~,~L 1 ti's , <br />