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-8- <br />Certification: <br />As ;gin authorised rupresentatitie of the applicant. I hcreby certify that the operation describe-d has met the rninirnulTt <br />no {uirements ofthe Billowing tcmts and conditions; <br />I. l n tlru hest uf'm} line) «ledge, all significant. valuable and permanent man -made structur((s) inexistence at the tinic <br />this application is filed. and lex ated %i ithin 2(9) feet ofthe proposed afti ctc:d area have twsen identified in this application <br />(Section 34- +2.5- 115(4Xe),C.R.S.), <br />2. No onininy operation will hr located on lands ".here ouch operations are prohibited hr law <br />(Section '4-52 5 -1 ISOX0- C•. ,S_ <br />As the applicant:0p - ,Ater. l des not have anS extrac:tirrdexpluration operations in the State (if i'i�i(.trctdcti currcntl� in <br />t,liatior, of the pro» isii >rrti (if the Colorado Land Reclamation Act for the Fxtraction of Construction Materials <br />SCOion 34- 12 5,120, C K S.) as determined through a hoard finding. <br />-f. 1 understand that statements in the applicatipn are being (Wade under penalty of* per }un and that tak(l st(ftenic tttw <br />made heroin are punishable as a Class I misdemeanor pursuant to Section It3 -K S(t3, C'KS. <br />7hit Orm has been approved hr the 11ined Land Reelamadon Board pursuant to sec&n 3 *- 32.5- 112,C.R.&, oflite (Mora& Land <br />Reclamation 4d jor the I aYraeYion of ('ans?ru,,tion :'N"aterlal t. 44P aheration or modification ication of this farm shall result in vrritling ana <br />pe•rnrii istrted on the altered or nrodIfled farm and subject the nperalor to cease and desist orderrc and elvil penalde i free operurinl+ <br />withreut a permit punuani to section }�- 31.5 -l13. (:R S; <br />,tx fwd and dated this ! ' da} T- <br />_____ <br />If'C'orporation Attest (Seal) <br />Applic ant,'( f rator or Company blame <br />Corporal(: Secretar, or Equivalent <br />Town/Cit4'C'oun €y° Clerk <br />r <br />I fie 1, ir('i''e)Ink! vistrurnent vt' s acknoµ o + <br />1, fecl'ed fsefi�re rtzc this _ <br />A <br />e j el 1` <br />� f day of !.l cj r r'::' d i-Ij <br />L . <br />t_ ' 1.__ t.i _'.! -- ... as,:, f �•'',! <br />. _.. _ r of r ! ..L`'f 1, /r ? ' <br />� �_•i'r <br />�x <br />r A T i p / <br />to <br />Notary Public. <br />i ;K <br />N v Commission expires' <br />., ;NATURES MUST BE <br />IN BLUE INK <br />You rnu,t p(,:,t su +rent t t ton of the proposed <br />tssiii1 2� <br />mina' site to clearly identify the site as the Iocation of"a <br />ax�;eES , <br />—6 <br />