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0 <br /> <br />-~- <br />Certification: <br />As an authorized representative of the applicant, I herelrv certify that the operation described has met the rtrinimum requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) m existence at the time this <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by lave (Section 34-32.5-1 l5(4)(Q, <br />C.RS.; <br />3. As the applicandoperator, 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 E~vaction of Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board fording. <br />4. I understand that statements in the application are being made under penalty otperjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursu t to Section 18-8-503, C.RS. <br />Signed and dated this ~ da}~ of Qom` <br />_:.: \ _ ~ - <br /> <br />_ ~ - . <br />-~~ ]f Corporation Attest (~eal)_ - <br />Signed: <br />Corporate Secretary or Equivalent <br />Tow~n/Ci[v'/County Clerk <br />State of Co%/'au~C7 ) <br />ss <br />County of L7a~'z?/d ) <br />The foregoing instrument was acknowledged before me this ~ day of ~P ~ieM 6'P r , ~Gt00 <br />by R/c11a~t/ .S~P,f~t~o .~ as (l; ~_ 1~/~S.z9Y~t-~ of Qoar_n~ i~o^K ~PSou~~eS <br />~pRlf, Py~~~ . <br />•CVIIfIM = lv -' Public <br />~~~ <br />J~ bh' Commission expires: ~ ~~~ a00 y <br />SIGNATURES A4UST BE [N BLUE INK <br />M `mm\shart'zsfo,rm4673C01?.APP (07/17/:000) <br />ll[le: ~t'r'i ~ /'aq~'~ <br />