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-~- <br />Certification: <br />As an authafred representative of the applicant, I hereby certify that the operation descarbed has met the minimum <br />requirem®ts of the following terms and conditions: <br />1. To the best of my knowledge, all signiScant, valuable and permanent man-made structure(s) inexistence 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 extrackion/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 statements in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanorpursuant to Section 18-8-503, CRS_ <br />Tl-- ,~,, ~~,,,~,,,, ~~~~ <br />Signed and dated this 2 s day of M fi`t' . !1/~. <br />AG~RG-~iFiF ,zNOa.S~t'z ~ ~' - W G 2 ~ IN G <br />Applicant/Operator or Compaay Name <br />sighf /, ~ ~ ~L <br />Title: v ` c-~_ fez X433 ~ ,~ ~ i <br />State of ~~~ Q <br />C ) ss <br />Couuth• of Sow' <br />The foregoing instnmmea),was acknowledged <br />by ~CAr~.ee ~~~ as <br />If Corporati~ Attest {Seal). ~, ; <br />,. _ . >,. <br />~~ ~ - o <br />n =: ~ ti ~- <br />s;gned: <br />Q~f , <br />bef.or//e me~~~~ r Ste! ~ day of ~ a 00 <br />Vo~7'/eP~~ of ~~ `7~i~.t.r~ _((K,Q~e~i~. <br />~vX~a/+JX~ 1G~umu~u <br />DARSARA S. <br />SDDERMAfiiN <br />Notary Public <br />My commission expires: O~'La S,~S <br />"~' SIGNATURES MUST BE iN BLUE INK <br />M:~vVhae~~Cmo-xtiov trzm~ tia~srmo» <br />