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RECEIVED <br />MAY 3 1 2002 `~ ~ <br />Certification: <br />Division of Minerals and Geology <br />As an authorized representative of the applicant, I hereb}- certify that the operation described has met the minunum <br />requirements of the following teens 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 of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. Na mining operatirn, will be located on lands Rhere such operations are prohibited bylaw (Section <br />34-3~.~-1 i 5(4)(fj, C.R.S.; <br />3. As the applicant/operator, I do not have any exrtraction/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 fmding. <br />4. I understand that statements in the applicarion aze being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class I misdemeanor pursuant to Section IS-8-503, C.R.S. <br />Signed and dated this 29th day of May <br />Moffat County Road Department <br />Applicant/Operator or Company Name <br />Billy E. Mack <br />Signed: ~1~~ti, ~G ~~~ek~ <br />Billy Mack (Road Supervisor) <br />Title: Road Supervisor <br />State of Colorado ) <br />Moffat ) ss <br />County of 1 <br />2002 <br />If Corporation Attest (Seal) <br /> <br />i-l <br />or Equivalent <br />mtv Clerk <br />The foregoing instrument was acknowledged before me this 29th dayay 20 0 2 <br />by Billy E. black as Road Supervisor of Moffat Coun y <br />- = - - - ~ Notary Public <br />~'- c^ ~ - - <br />~"•,'`- - ,' My Commission expires: ~ 7., , ~~ ~ <br />_- : <br />SIGNATURES MITST BE IN BLUE INK <br />M:~'1BI)CQ.9NFORD1S2823CO17.APP osn 9nooz <br />