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<br />_g_ <br />Certification: <br />As an authorized representative of the applicant, 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, all significant, valuable and permanent man-made structure(s) inexistence at the time <br />this application is filed, and located within 200 feet of the proposed affectt.d area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, 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 Extraction of Construction Materials <br />(Section 34-32.5-120, C.R.S.) 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 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This farm has been approved by the Mined Land Rechmnation Board pursuant to section 34-32.5-112,C.RS., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-32.5-123, C R.S. <br />Signed and dated this 5 day of Ayi o.4- 01? <br />l lonnO1 9")UPCps"Inc <br />Applicant/Operator or Company Name <br />Signed C <br />Title: ?T-61,C. <br />State of r_060 AO ) ss. <br />County of <br />If Corporation Attest (Seal) <br />[l <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Signed: , <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk I <br />t <br />The foregoing instrument was acknowledged before me this ....., ? - d.ay of I t Z OC6 , <br />-,by K!?-?.-C? as <br />7 <br />: SUMMER M Notary Public <br />JONES <br />(P <br />0" <br />"Yrl My Commission expires: <br />MY COMMISSION EXPIRES: <br />SIGNATURI±S Wffftblg, 16jIBLUE LINK <br />