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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 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. 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 34-32.5-112,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 /> Signed and dated this day of t;, O'e, a0/ <br /> k&k-hI? /VII[I7tC Id If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed: � ��7 r /�.-cz`' ` Signed: �► <br /> Corporate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> State of Oo(or b ) <br /> 1 )ss. <br /> County of <br /> The foregoing instrument was acknowledged before me this n_day of <br /> by as111 _/' !�PI'1�' of <br /> '0 ilk <br /> �1�1111111111t!/�bi <br /> ••...... • �,9 ,- tary Public <br /> TARJ:••N -_ <br /> _ —0-0-0— <br /> •....... — My Commission expires: <br /> io9ffi OF Cam- lP��� SIGNATURES MST BE IN BLUE INK <br /> �• •OQ' <br /> RE <br /> f"//t��i l \",`You must post suce otices at the location of the proposed mine site to clearly identify the site as the location of a <br />