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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) 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 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 Boardpursuant 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 ally <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 pernrit pursuant to section 34- 32.5 -123, C.R.S. <br />�7 / ` AT Ig1 <br />Signed and dated this y� 7 day of Li:-7e � r4,( r, /-4, a 01 <br />,\\\\ �. <br />If Corporation Attest ���F, 5�,, <br />Applicant/Operator or Company Name �?e "•.�y "_ Z <br />P4 OR <br />Signed: �1 �� <br />Title: Vice President <br />Si <br />Corporate Secretary or Equivalent <br />Town/City /County Clerk <br />State of 0 31WC00 _ _) <br />ss. <br />County of 'PC(SO ) <br />The foregoing instrument was acknowledged before me this <br />L4— , bYTU KI��� as V X r <br />I —ITH <br />My Commission exp <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 />>, <br />