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-8- <br />Cg caSan: <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) in existence at the time <br />this application is filed, and Iocated within 200 feet ofthe proposed affected area have been identified in this application <br />(Section 34- 32.5- 115(4xe), 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), CRS.; <br />3. As the applicantloperator, 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. I understand that statements in the application are being made under penalty of perjury and that Use statements <br />made herein are punishable as a Class I misdemeanor pursuant to Section 1841-503, C.R.S. <br />.This form has been approved by the Mined Land Reclamation Board pursuant to section 34- 32.5- 112,CRS, of the Colorado Land <br />Reclamation Actfor the Ecovedon of Construction Matedak Any alteration or rmodijk ution of this formshaQ result in voiding any <br />peradt issued on the altered or modfied form and subject the operator to cease and desist orders and civil penalties for operating <br />without a pmnli pursuant to section 3¢32.5 -123, CRS. <br />Signed and dated this %3b day of + <br />Signed: <br />Tithe: Cc,— , . , I OZ-t1. <br />State ofCI otc�rcicio l <br />) ss. <br />County of V-')e 1 la-- <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City /County Clerk <br />The foregoing instrument was acknowledged before me this 13" day of FVsIn r <br />�aN , by _ lZo��r -`� �C2 t F �1a� as Cap n 4 �� E na In ec r of <br />AS..HITON R. 1POD s-C <br />NOTARY IP U-0 Totaryl?ublic(3)�y�—', <br />ST-AXE Or � :C! OR DO <br />tvOi;,RY !O VZ-i 33+031313 y Commission expires /`'1c../ ,d,T, ,?o /7 <br />Y Cor^miss:rn Expires Mx1.2, 2017 <br />SIGNATURES MUST BE IN BLUE INK <br />