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-8- <br />Certification: <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) 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- 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. I 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- 31.5- 114C.R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this farm shall result in voiding any <br />permit issued on the altered or modifed form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34 -3Z.5 -123, C.R.S. <br />Signed and dated this 2nd day of April 2014 <br />Huerfano County Government: <br />Applicant/Operator or Company Name <br />Signed <br />Title: <br />Chairman <br />If Corporation Attest (Seal) <br />State of C O i' Z o ) <br />) ss. <br />County of <br />The foregoing instrux4ptit acknowledged before me this �— d <br />c? 2' by Maly "�_ as .11 ciz') <br />r <br />DENISE R VIGIL. <br />NQTANY PUKIC <br />STATE OF COWRADO <br />NOTARY - ID 19954014699 <br />Mr COWMS t VMS SEPTEMBER 29.2015 <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />Notary ruoitc <br />My Commission expires: t' 49 I � <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 />