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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 /> I. 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(4Xf),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 i8-8-503. C.R.S. <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-/I2,GR 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 / day of 01&i1...h .44/‘ . <br /> 4Aa't l9 -27is dref,i c.-(VCA?A, i f Corporation Attest(Seal) <br /> '4plicant/Operator or Company. • - - <br /> Cc--Li --SN't--"L-'" <br /> Signe _ Signed: <br /> Corporate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> State of ) <br /> )ss. <br /> County of ) <br /> The foregoing instrument was acknowledged before me this / day of MefrAGA <br /> 01014,by 304 n / h li g, as ArJoh4/ w t APA..'.cds.. Of /�4.A.0 ji7r c <br /> 75114, " i. - " <br /> V fd/t''te& t . . <br /> "IS DO <br /> Notary Public <br /> bLcC <br /> Is-.',r. Jr COLORA3 �� <br /> NOTARY ID 19894 <br /> 002156 My Commission expires: <br /> MY COAMuiIS$IQN EXPIRES MARCH ^^17 <br /> SIGNATURES MUST BE IN BL INK NNIE N. DAVIS <br /> Nr' "r •RLIC <br /> You must post sufficient Notices at the location of the proposed mine site o clean identifyrihe-sV the I ation of a <br /> i..,_ ..,ON EXPIRES MARCH 7 2017 <br />