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<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) in existence at the time this <br />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.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(0, <br />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 (Section <br />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 made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R-S. <br />Signed and dated this -3 ` A day of -e D"Ir-f Z 1 a <br />se;?er4 'E r..?c r('se3 .L(_ C <br />Applicant/Operator or Company Nark-- <br />If Corporation Attest (Seal) <br />Nignee Signed: <br />/ Corporate Secretary or Equivalent <br />Title: C' w ne( / a" u n a d p r Town/City/County Clerk <br />State ofC _ d lt?%? i ) <br />? 1 <br />County of ?ry ?.i u54_e )ss <br />r-' ) <br />i <br />The ffor-e- oing instrument was acknowledged before me this 3 day of r' x201 y , <br />by / 1r o?c1 ?rz ti? as?.d: , of d <br />?l ?- <br />?_? ?;r_b <br />N Public <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK