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-8 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the oyclatiuu dcaelibed has Luet tho ulilliurum <br />requirements of the follow illg TCL L113 alld Cvrlditiiva: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made strucrure(s) in exisic lxc at the tilLle <br />this application is filed, and located within 200 feet of the yloyaaed affected area nave been iacutified iu tnia application <br />(Scctio.l 34-32.5-115(4)(c), C.K.S.). <br />2. No mining operation will be located ..L lords Where Such oyeratiu"3 are pohibited oy law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any exuaction/e�yloratiorr oyeLatiolls 1rr the State of Colorado c..cutly ul <br />violation of the provisions of the Culmado Larld Keaiamatio11 Act tol the hatractlou ut Cuuatructiun Materials <br />(Scmim, 34-jz.J-1Z0, L.K.S.) as aeturmined through a Board fording. <br />4. I understand that statements in the application are beilrg made under ye.alty of yeL' l.ly and that false atatcLncuta <br />made herein are punishable as a Claaa 1 aL15dumeallvl pursuant to Jcctioa is -8-303, L.K.S. <br />This jar.n hus been approved by the Mined Laud Reclamation Board Fa sa=,.t to sectio,. 34-32.5-112,C.R.S., of the Ce1v,..7v Lu,.(Z <br />KuU1unla6a,r Ait jv, the L. -.t, artian vj t,wnatrucdun Aluleriuls. Any alteration or ntodijlcation of this forst shall result in voiding any <br />permit issued on the altered e, .,a7dijrrr7ja,1,1 Rna subject the vperatut to eeuse ana aes;at ari3ers Ana etvil penalties jar aperatirls <br />Ivit/tout a permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this 7 yO4 day uf 04-0–Q2'ot 5 <br />oaZ4— ,r te If Cvlyolat1u11 Atteat (Seal) <br />Ayylleant/OyeLatvL 01 CVLlryally auLC <br />,y�I}, <br />Signed: �� S1�1L <br />orate Secretary quivalen <br />Title: _rcasl��� : y <br />Town/City/County Clerk <br />State of r0zt::�gz ) <br />ss. <br />County of . }) <br />The foregoing instrument was acknowledged before me this / `% day of.rj.�✓ , <br />by%limo/Io—as /5 `.,�0ft2�L��tc . I <br />PEGGY E. RIPPY . <br />NOTARY PUB[IC; Notal—Pu 1' <br />STATE OF CUCuRAUu y <br />NOTARY ID ;Flas64018r79 <br />Mr C&iminaian expires November s, Zu io My Commission expires: <br />SIGNATURES MUST uu uv tsl.uh uvn <br />You must post sufficient Notices at the location of the proposed rlril,e site to clearly identify the site as the locauo,.. of 21 <br />