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-8- <br />Certification: <br />As an authorized representative of the applicant. I hereby certify that the operation described has met the mininunn <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man -made structurc(s) in CXistcncc aI the I irate <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 -1 I5(4)(e). C.R,S.). <br />2. No mining operation will be located on lands where such operation, are prohibited by la« <br />(Section 34- 32.5 -I I5(4)(f), C.R.S.: <br />3. As the applicant /operator, I do not have any extraction /exploration operations in the State ofColorado currenlIN in <br />violation of the provisions of the Colorado Land Reclamation Act line the I'.mraction of Construction Materials <br />(Section 34- 32.5 -120, C.R.S.) as determined through a Board finding. <br />4. 1 understand that statements in the application are being made under penalty of perjury and that false statemenh <br />made herein are punishable as a Class I misdemeanor pursuant to SCCli0ll 18 -8 -503. C.R.S. <br />Thic fonn has heen approved hr the Alined Gant) Reclamation Board purstiant to section 34 -32 5- 111,('. R S.. c f the Colorado Land <br />Reclamation Ael fur the Extraction c f Construction Material %.: t nr alteration or ntodi icnliuu c f IhA fonn shull result in raiding anY <br />permit issued on the offered or mortified form and subject the operator to cease and t/Mv orders and civil penalties for operating <br />without a permit pur uout to section 34 -32.5 -123. C.R.S. <br />Signed and dated Ibis /y day of <br />vnlr� MD2=n'1 G5., _-,j�joo, <br />Applicant /Operato or Company Name <br />Signed: <br />Title: • <br />State of d o/or- a-d(f) ) <br />L^3 t� ) ss. <br />County of ]tj ) <br />IfCorporation Attest (Seal) <br />Signed: aAA <br />Corpe rate Secrela y or f:yukalen <br />Tossn /Cilti /('ount� Gerk <br />The foregoing ((instrument vas acknow edged before 11W tills 7� day nl A� 1� <br />by �iil�1 1 • VC7� �C'� as �°Si tr'Jl of, <br />Notary public <br />My Commission expires: �% - -- <br />SIGNATURES MUST BE IN BLUE INK <br />You must post sufficient Notices at the location of the proposed mine site to clearly identify the site a, the location of*,, <br />