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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) 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(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. 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 I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved by the Mined Land Reclamation Boardpursuant 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 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 permitpursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this 04�h day of <br />��pha1t��i .�alti es C"Ex <br />Apple ant/Operator or Company Name T <br />Signed: <br />an f{urrr- <br />Title:Fr'ES�IdEfq-- <br />State of C__-' / o ✓icd c' ) <br />ss. <br />County of "A S ) <br />The foregoing instrument was acknowledged before me this <br />ao/S, by �a h �/V fi Gc n as P ct'e, <br />t�S <br />�Pf'TgNE. <br />�.9� <br />:'�► <br />SIGNA <br />If Corporation Attest (Seal) <br />Signe <br />day of Z /V , <br />of lf Slocc"alfi'esC� c, <br />. 99y�3oS�y <br />No Public <br />My Commission expires: <br />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 />