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• <br />=~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115 (4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(£), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.) <br />as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~ day of 2G7G-L~cJ- ~~~~. <br />Ce~c-W~~ 1 ~°~ a-~^~ aovi~ ,~J~~ If Corporation ?ttest (Seal) <br />Applicant/Operator or /C~o~mpany Name <br />Signed: ~ l~hi~/~ Signed:~i ~~ <br />Corporat Secretar~~ or Equivalent <br />Title: F~ ~' S Town/City/County Clerk <br />State of ~~~hJ'0.C~i1 ) <br />``11 ) ss <br />County of \`~~ (~'t~ ) <br />The foregoing inCstrument w`as acknowledg1ed before me this ~~day of ~(V!(A,rl1^u ~, <br />bY~~C: n-\(: C: ~[.f~..~(, i~2 as ~(~y (l r~~ ~U ~`i t _ of l~F~.. ~P., l fl~l lt~Ct (~('~ <br />r <br />Notary Pc <br />My Commission expires: .~I I V I ( Xi <br />SIGNATIIRES M(7ST SE ZN BLIIE INR <br />0"0/26/97 2823FC0. 112 <br />