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-x- <br />('trtificatiow <br />As an authorized representative oft he applicant, i hereby certify that the operation described has met the minimum requirements <br />of (lie 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 ofthe proposed aflectcd area have been identified in this application <br />(Section 34-32.5-1 I5(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-1 15(4)(f). C.R.S., <br />3. As the applicanvopcrator, 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 Hoard finding. <br />4. 1 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 I misdemeanor pursuant to Section 15-8-503, C.R.S. <br />rhA./'ornr has been approved hr the .lfiteed Land Reclutnalion Board pursuant to section 34-32.5-112,C.R.S., of the Colorado Land <br />Reclanratio,r Act for the L traction of Cons7ruction Malerials. , fit r- alteration or ntodilicutiott of this fin-ne shall result in voiding an'I- <br />perneit issued on the altered or modified forte and suhject the operator to cease and desist orders and rir•il penahies fit- operating <br />without a permit pursuant to section 34-32.5-123, C.R.S. <br />5f <br />Signed and dated this -- -?_- day of _ _ li?!7 2 U C1 % ?' <br />09, <br />IfCorporation Attcst'6i <br />Applicant/Operat or Company Name Y W -4 <br />Signal: Signed: <br />- - 1 <br />Corporate SccrKary or Lquivalcm <br />Title: -e Town;City County Clerk <br />Slate. of LOc.,? 'AA4------- -- --- -1 <br />Comity of Alt<k ) 5S. <br />) <br />I•ltc lul?cu r,?, irr;trtmu;nt ??: ,:;knov Ird red before me this zZJ? <br />bv 41, <br />?, as [Y C A s S F.d St,, ( (na /I . Ai t <br />f'ETc? $ t t c?G.,y ?; N i) dis.d uN f-ro <br />C JUN r•/ <br />Ntll' ry f'ubli? <br />NIN ('„nnni,?sion cspires: d <br />tilt:\ ? I 1 i(I ? III ti I Ii N' I\ lil t I I?h <br />