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-8- <br />Certification: <br />As an authorized representative of the applicant, I 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 a y 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 t irough a Board finding. <br />4. I understand that statements in the apl <br />made herein are punishable as a Class 1 mi <br />This form has been approved by the Mined Land R <br />Reclamation Act for the Extraction of Construction <br />permit issued on the altered or modified form and <br />without a permit pursuant to section 34 -31.5 -123, ( <br />Signed and dated this 2nd day of <br />Huerfano County Government <br />Applicant/Operator or Company Name <br />Signed"`- <br />Title: Chairman <br />State of &A 601.1.0 ) <br />) ss. <br />County of ILA ) <br />The foregoing instrur#ent was acknowledged befc <br />k by 1; <br />SIGNA <br />are being made under penalty of perjury and that false statements <br />Dr pursuant to Section 18 -8 -503, C.R.S. <br />ion Board pursuant to section 34-3Z 5412,CR.&, of the Colorado Land <br />Is. Any alteration or modification of thisform shall result in voiding any <br />the operator to cease and desist orders and civil penalties for operating <br />2014 <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City /County Clerk <br />n <br />me this r day of <br />GIL <br />/— <br />ILIC / Dd i <br />'RADO Notary Public <br />4699 <br />1lliER 29.2015 �. <br />My Commission expires: ! <br />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 />