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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 folloNN ing terms and conditions: <br />L I o the best of my knowledge, all significant, valuable and permanent man -made structure(s) in existence at the time <br />this application i,; filed, and located within 200 feet ofthe proposed affected area have been identified in this application <br />(Section 34- 32.5 -1 15(4)(e). C.R.S.). <br />2 No pining operation x%ill be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(0, C.R.S.; <br />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 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 , t ct for the Lxtraction 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 purmant to section 34- 32.5 -123, C.R.S. <br />Signed and dared this day of I< tlCr,yr <br />jll[rlil , - tali :,iiIr <br />Applicant/Operator or Company Name <br />Sinned: <br />Title: President/General Partner <br />State of c4 ) <br />ss. <br />CUimts Of_ <br />r <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City /County Clerk <br />The toregoing instrument %%as acknowledged before me this r. ,i day of <br />C =�. h\ as / r t -1,V e , l of <br />a LL D. SCHAFERARY PUBLIIC OF COLD Notary Public <br />Y ID 19954016062 ION EXPIRES 12106/2016 My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />You mint post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a <br />