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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 minimum <br />requirements 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 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 <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. 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 1 misdemeanor pursuant to Section 18 -8 -503, C.R.S. <br />This fora has been approved by lite Mined L(inu/ Reclamation 13otrrdpursitaut to section 34 32.5- 112,C.R.S., of the Colorado Lard <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in volding ally <br />perinit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a perinitpursuant to section 34 -32.5 -123, C.R.S. <br />Signed and dated this 23 day of OC-T-T% Z Zo�3 <br />Pete Lien & Sons, Inc. If Corporati eal) / <br />Applicant/Operator or Company Name 1 <br />i <br />Signer <br />Title: <br />State <br />) ss. <br />Signed— <br />Secretary or Equivalent <br />Town/City /County Clerk <br />County of LA�r rn£� <br />The foregoing instrument was acknowledged before me this a3" day of N:l!l — Di 3 <br />by �j,L_�. �,.. � nr.o�a� as 'i�Ro►n��QJ\_ of Patter 6VA .4 561rt,o+ <br />Notary Public <br />My Commission expires: u aoI <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 as the location of a <br />