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<br />-~- <br />Certification: <br /> <br />As an authorized representative of tfie applirant, 1 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, ali significant, valuable and permanent man-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 34-32.5-1 I5(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-I I5(4)(f), C.R.S.: <br />3. As the applicant/operator, 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 Extraction of Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board finding. <br />4. 1 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 />TIC /~ p <br />Signed and dated this day of L JC- T~ ~ ~ 1 q q -1 . <br />~~4M ~3 C ot_o ~ v , LN c <br />ApplicanUOperator or Company Name <br />sign ~ ~~ <br />Title: \f 1 C r ~(~ `BSI '(~ ~N T -/"C~N~ t N ~5 i RA T •o~j <br />State of ~4-e~/`- ) <br />ss <br />County of j'~- ) <br />The foregoing insttum~j was acknowledged <br />by /f(s13~1,~ ~ /~PJ/ as <br />If Corporation Attest (Scat) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/Ciry/County Clerk <br />day of ~ l <br />r--' ~, <br />_ ~ .` ~. <br />- i <br />-:_ <br />in 1- <br />e•l ~ ~ <br />Notary Public <br />My Commission expires: l/C~+~(. ~~ ~(~~ <br />SIGNATURES MUST BE IN BLUE [NK <br />M:N4h\SHAREIVSFORhL5~3B]JCOII.MP 03/ION9 <br />