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-~- <br />Certification: <br />As as authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requir~ts of the following terms and conditions: <br />1. To the best of my knowledge, all 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 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicant/operator, I do not have any exiraction/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 that statem~ts in the application are being made ands penalty of perjury and that false statements <br />made herein are punishable as a Class 1 eanor pursuant to Section 18-8-503, CRS_ <br />Signed and dated this ~~~ day of ~ r'i' ~ ~' ~ T ~ 0 d 3 <br />,, <br />]11 D rF~ I ~ I M QS to N-~ CO,, l,vc • if Corporation Attesf~ ' ----: °`'--. <br />ApplicanUOperatororCampanyName ~~ ~'~`~ :~~ <br />_. . ~ ~ a <br />nn :_ <br />Signed: G1/~L~ ~ Signed: ~~ '~' . '~~ `^ <br />r~ Corporate'Secref~ or Equival <br />Title: l ~e 3 : ~ e A/T Town/City/County Clerk <br />State of <br />ss <br />County of ~~,~~$ ) <br />0 0 -ri> n ~ <br />The foregoing instrument was acknowledged before me this I S `day of 1~.~..~ot2~~- ,2 Da3 , <br />by ~ ~ S-F-ee.~ P as \!7~ rc-E' of ~(Y~r,~,-1-1~ rr~~Dr~¢ ~ <br />.. Notary Public <br />= My Commission expires: ~e-1 S` 'ZOCX~ <br />SIGN?iTURES MUST BE 1N BLUE INK <br />m:~~n~ trz.mo ttarsrzoot> <br />