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-7. <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, aH 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.RS.). <br />2 No mining operation will be located on Iands where such operations are prohibited by law (Section 34- 32.5 -I IS 4 <br />O <br />C RS.; (f), <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 mad e <br />herein are punishable as a Class I misdemeanor pursuant to Section 18 -8 -503, CR.S. <br />Signed and date$ this _L9— day of _ ^- ' !` 1�� Z <br />o , <br />—_` <br />Applicand ;Mator or Company ame <br />Signed:� <br />Title- <br />State of <br />) ss <br />County of ) <br />If Corporation Attest (Seal) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The egoing instrument was acknowledged before me this day ofll /�Y1Y1.T <br />by 1 h; ten. �/1,4Li <br />Notary Public <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />