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-8- <br />Certification: <br />As an authorized representative of the applicant, l 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 pennanent 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 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. I 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 thisform shall result In voiding any <br />permit issued on the altered or madified form and subject the operator to cease and desist orders and civil penaltles for ing <br />without a permit pursuant to section 34 -32. S -123, C A& �tATY C <br />Signed and dated this �3 day of ��� !-57 <br />649' <br />Applicant/Operator or Company Name <br />Title'`{ <br />State of Q Ot 1. Y ki�:L <br />_ ) ss. <br />County of JEJ ISMC% U7 ) <br />If Corporation Attest (Seal) <br />SEAL <br />f �4 <br />�O <br />Signed: ��,Ja crr(.(6t_ Alv'..(4[Grx� <br />Corporate Secretary or I vlent <br />outy Cler k <br />k Town'Ci <br />The foregoing instrument was acknowledged before me this day of ­S?K ALA <br />Irby c vin L� �. �':���GL9. f as , UY\'� ,� t CA S of Vww� tr'C yr_ <br />1 <br />JA14ELLE MIKA WILLIAMS <br />NOTARY PUBLIC N tary Public <br />STATE OF COLORADO <br />r4C)TARY ID 200N031474 <br />MY C.,"A l +SSIQN EXPIRES ocroBER 21• 2017 My Commission expires: DI <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 />