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r <br /> i <br /> I <br /> - 8- <br /> i <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)(0,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. 1 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-/23,C.R.S. <br /> Signed and dated this day of `71&y-em LL-L— J C IV <br /> V C_6 qQ�Ps L LC Tf Corporation Attest(Seal) <br /> Applicant/Operai4 or Company Name <br /> I I Signed: (1i�t.G� V Q/rt �Ia'� Signed: AIA <br /> Corporate Secretary or Equivalent <br /> Title: MANAGER Town/City/County Clerk <br /> State of AD 1-b c (� ) <br /> County of We I& ss. <br /> The foregoing instrument was ackno ledged before me this day of No ve,'K_b� <br /> Z.0 Imo, by SON Q/1ft )�L AN C � LA/itL/ira ef'z -- of re,5vJes,LLC <br /> LEUNG Y. CIIENG C,11A <br /> WrA RY PUBILICNotary Public <br /> fE OF ColL('rRADORY ID 20044021652'10N EXPIRES JUKE 27, 2016 My Commission expires: Z� ZU� <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 />