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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 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 ctoerating <br /> without a permit pursuant to section 34-32.5-123, C.R.S. <br /> Signed and dated this 3 day of Pc 2 C! • <br /> d id fif. C-0 n.rrew If Corporation Attest(Seal) . <br /> Applicant/Operator or Company Name <br /> % <br /> Signed: 'lad Cl. ��eC(. 75.✓e� <br /> Signed: '> <br /> y Corporate Secretary or Equivalent <br /> Title: ,Cec rG rot ry. / f"'j(OSK ee f Town/City/County Clerk <br /> State of d f. --r•. ) <br /> ,LL ( ) ss. <br /> County of P11 1 t ) i <br /> Thecforegoingi tru ent was ac owledged before me this 1. / <br /> day of FtI. <br /> I`�.;•-Y <br /> by a t as S1c v 1 " T/t y r of ._o 479-Cc NIG4 116411 <br /> 1'1.114 .4 .1111{/46 <br /> 6 <br /> -',11-f <br /> . i . MICHAEL HOLLI$ ' Notary Public <br /> SEAL <br /> �• NOTARY PUBLIC.Raw , r I <br /> EN CO118, My Commission expires: t 1( I S` 2.42- <br /> SIGNATURES <br /> .42SIGNATURES 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 />