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-8- <br />Certliica n: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the rninimum requirernerits <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man -made strueture(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 Iocated on Inds where such operations arc 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 faisc statensertts <br />made herein are punishable as a Class 1 misdernemm pursuant to Section 18-8 -503, C.R.S. <br />TM fonx has beex approved by theMfaed Lax4 Raaratxstfox AmW pm&uw to secdox 34- 325- HZCR.£, of hire Colorado ,Lead <br />Redamadon Ad for the EWracdon OfCoxstntcdoM Materials. Axy dteradaN or nodykadox of (M form :Ball rem& U >Mleg any <br />parer& issued on the altered or mowed form and subject the operator to cease and dfesist orders and dvil penes for operadng <br />without s perm pursuma to sedlox 34-M423, CRS <br />Signed and dated this 1;.:. _ day of /11a�%Y 2 <br />/ %1,/_ <br />Title: OA 4-6�6 Q <br />State of <br />} ss. <br />County of -I t�h1ue 1 <br />The foregoing instrument was acknowledged before me this <br />fly as V d n r h <br />S <br />IfCorporation Attest (Seal) <br />Signed: Y <br />Corpo or Equivalent <br />Town/City/County Clerk <br />My Commission expires: tV • U ?—Dc`t' <br />SIGNATURES MUST BE IN BLUE INK <br />(Appmed 03/1 rnoasj <br />