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-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certifythat the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To die best of my knowledge, all significant, valuable and permanent span -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(4Xf), C.RS.; <br />3. As the applicantloperator, 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 malty 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 />rhls fora! has been approved by the Mined Land Redanadon Beard pursuant to region 34- 3ZS -11 X C RS, oftbe Colorado band <br />Redamallon Ad far the F- %*aettan of Construefion Materialk Any alteration or modif%adon ofthis form shaft mob in votdhWany <br />permit Issued on the altered or modified form and subject the operator to cease and desbr orders and ciW penalties for operaling <br />without a permit pursuant to salon 34-315-123, Cub.£ <br />Sighed and dates this �D �p day of &a' t6M 6f -9 <br />3-vUA". e L 1E -,7Vn 's_ L&C. <br />Applicant/ or Company Name <br />Signed <br />Title: / %t AIA 6d-A-9 ! ` /E,✓tR'FQ�_ <br />State of ca <br />) ss. <br />County of <br />The f instrument was acknowledged befon <br />If Corporation Attest (Seal) <br />NIP SAN k <br />•r ` <br />Signed: <br />or Equivalent <br />Town/CitylCounty Clerk <br />iViy comnrissiot CO�mtt 7M <br />SIGNATURES MUST BE IN BLUE INK <br />