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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 fording. <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,CR.S , of the Colorado Land <br />Reclamation Actfor 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 if L day of TA- L) OA (Z7 219 /o . <br />C010 -.bd• St►nt,. 0uw.or�i2.t .2.."10s c. <br />Applicant/Operator or omphlty Name 1 <br />If Corporation Attest (Seal) <br />SignedSigned: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />Title: E(v & ft,4L i f,4 I 662 <br />State of <br />ColoraA6 <br />r�^ ) ss. <br />County of Ca Pet 6 ) <br />The foregoing instrument was acknowledged before me this I <br />20[14, by ?durl i X14.. -pYiP_ v,P 5 as <br />ANA B GARCIA <br />Notary Public <br />State of Colorado <br />Notary ID 20064051013 <br />My Commission Expires Dec. 2224, 2018 <br />day of [jt,,n Vaay <br />an d 1 - of (Alo'add sone <br />vietQ. , rrleS <br />• <br />Public <br />My Commission expires: <br />RES 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 />