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<br />Certification: <br />As an authorized representative of the apphcant, 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 my knowledge, al] significant, valuable and permanent man-made structure(s) N existence at the time [his <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-I 15(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 3432.5-115(4)0, <br />C.RS.; <br />3. As the applicant/operator, I donor 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.RS.) as determined through a Board finding. <br />4. I understand ilrat statements in the application are being [Wade under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~~ ~ day of it'I u ~t,~ , ZUO l <br />ACA PrUd.uG>S ~~ . <br />ApplicandOperator or Company Name <br />Signed: l Af i,[~ <br />Title: ~i ~-<, .~~r-~,f <br />If Corporation Atte§C(Seal) <br />Signed: <br />C orate Secretary or Equivalent <br />TownlCitylCounty Clerk <br />State of ~ ~Or6< dU ) <br />~/J/~ /~ ) ss <br />County of Chu ~fP 2 ) <br />The forn//e/going instrument was acknowledged before me this /~f~ day of /~« ~c~ ,ton / , <br />by (/'far ~C'S Y NI...-n~ J as P~eS~~lw-,t of 11GA Pr~L~ 7...~ <br />N- c <br />My Commission expires: y'ot/ TJ,3 <br />SIGNATURES MUST 8E IN BLUE INK ,~ -:'"~ <br />. -. <br />.~ <br />