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-8- <br />Certification: <br />As an authorized representative of the applicant, 1 hereby certify that the operation described has met the minimum <br />requirements of the following terins 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 -t 15(4)(f), C.R.S.; <br />3. As the applicant/operator, t 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 />Thu form has been approved by the Mined Land Reclamation Board pursuant to section 34- 31.5- 112,C.R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of thisform shall result in voiding any <br />permit issued on the altered or modifred form and subject the operator to cea s `afr4 agsjs, 9rders and civil penalties for operating <br />without a permit pursuant to section 34- 32.5 -123, C.R.S. O V . <br />� 8 Rc '. <br />Signed and dated this �� day of %��6a..• r �Io •• ..ARa •. _ <br />_ sfC>'� •� in <br />Connell Resources, Inc. �? l�Corpo tio4ktes7(Seal) <br />Applicant/Operator or Company Name O ts�p►�•: <br />Signe <br />Corporate Secretary or Equivalent <br />Title: President <br />State of C_C -I$ a.- ) <br />) ss. <br />County ofc-�.r�e.r ) <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this 1 I AA,% day of <br />-ZQ a by C.ony1-1—\ \ as r�) re_S a.tka.v� �t of <br />AMBER C JORGENSEN <br />NOTARY PUBLIC Notary Public <br />STATE OF COLORADO <br />NOTARY ID 20134034207 M Commission expires: 5 <br />My Commission Expires May 30, 2017 y P <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 />