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-8- <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)(f), 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 perjure and that false statements <br />made herein are punishable as a Class I misdemeanor pursuant to Section 18 -8 -503, C.R.S. <br />This fornt bar been approved by lire Mined Land Reclamation Board pursuant to section 34- 32.5- 112,C.R.S., of the Colorado Land <br />Reclamation Act for the Fxtraction 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 -123, C.R.S. <br />Signed and dated this Z day of y �L r L) <br />itic <br />fCorporation Attest Seal SAW - <br />Applicant/Operator o ompany Name <br />1,3 <br />State of Cn l Orr:. O ) <br />ss. <br />County of 1 C-C, Cy�11( ) <br />Signed{ pordte Secretary o Equivalent <br />x- <br />r <br />Town /City /County Clerk <br />L" The foregoing instrument was acknowledged before me this ��- j day of )2' :'_0' `_A— <br />by f vJ t �, Si r '� 3 v1_;J as —� rY S APA A of P_tiA P 7,r. C _ . <br />KI=LIt o MAES Notary Public <br />NOTARY PUBLIC �- <br />STATE OF COLORADO �� I� <br />4, <br />OTARY ID 20124084237 My Commission expires: � L�V/ <br />i MY COMMISSION EXPIRES JAN. 8. 2017 <br />SIGNATURES MUST BE IN BLUF. 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 />