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-8 - <br />Certification: <br />As an authorized representative of the applicant, 1 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 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 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 1 0 t' day of 1.,1 O v .e v t 131 r , o7O ( 5 . <br />AGA edw S i 1 %C. . If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed: nA �, a,✓1 d <br />!m 1'� <br />Title: <br />State of (`p\Dro,. b ) <br />) ss. <br />County of Urge. ) <br />Signed:[ c.0 <br />Corporat Secretary or Equivalent <br />, .A ENT Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this I oWN <br />day of NstAgx\ izi <br />Dob, by CiNZ&•G.Q.\ CoiQ.ry\ci.(\ as ?rest. Ae r- of ,4c -Pt ? civ .\-s , =-^c • <br />k <br />BETTY CRITES <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NARY ID: 19954006312 <br />MY COMMISSION EXPIRES: APRIL 26, 2019 <br />My Commission expires: ' 'Z% — 20/9 <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 />