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-8- <br />Certification: <br />As an authorized representative of the applicant, [hereby certify that the operation described has met the minimum regrerarrents of <br />the following terns and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man -made strucuire(s) in existence at the time ties <br />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.ILS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34- 32.5- 115(4xf), 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 made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18 -8 -503, C.R.S. <br />skit form has been approved by the Mined Land Reclamation Board pursuant to section 34 32.5- 112,CRS,, of the Colorado Lo„d <br />Reclamation, Act for toe ExOattior" of ConsOadion Materials. Any afiaadon or modiJuxttion of Allis form +�Ata!! resudt�ir k ding ony <br />permit issued on the afYered or neod ywi d form and s"Jed the opermb., to cease and desist orders and dW pm far op a�ryiri►1d,'prt <br />a permit pursuant to section 34 -32.5 -123, CRS <br />Signed and dated this 7—( day of l 2om5 = <br />Q i ( _�..� t✓►w, v. �..'h• If Corporation Attest (Sett) <br />Applicant/O or or Company Name <br />Signed: Signed: <br />State of Casio raJo ) <br />) ss. <br />County of - e (k ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instnunent was acknowledged before me this �L s� day of ,-r'd se -- - , <br />by ro ae as _ so,fin g WL a�q, er _ of PAr 9401 •W <br />No Public <br />M.{minWWT\"f&=\CcMWu [ion 112 doc (Approved 05111 <br />My Commission expires: /Dl4fg" <br />UE INK <br />