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I <br />VT <br />n U <br />-8- <br />d <br />, <br />• t <br />Certification: _ _ _ J <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 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 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. 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 form has been approved by the Mined Land Reclamation Board pursuant to section 34- 32.5- 112,C.R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34- 32.5 -123, C.R.S. <br />��1111tli /tll /// <br />Signed and dated this day of L�� nu G t1 �� J0p` R. 4f���i <br />'Rp 0q <br />It,OG�ylr 91.tiil "7 A�B� G �s �`7 >��� / j%" If Corporation Attest ��F� SEAL <br />Applicant/Operator or Company Name?�'.Cs <br />... •_mss _ .(1. 5 <br />Signed: <br />Title: Vice President <br />State of Cu oy-CIC O — ) <br />ss. _ <br />County of <br />The fore -going instrument was acknowledged before me this <br />b JOY110—J as TU- <br />k- orporaic OGarGiary ur cyuivaicnL <br />Town/City /County Clerk, <br />1 M 11 1 <br />EVA 91077"11111"A <br />blic <br />My Commission exp <br />SIGNATURES MUST BE IN BLUE INK '!♦j �" <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 />