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- 8- <br /> Certification: <br /> As an authorized representative of the applicant. I herebN certitN that the operation described has met the minimum <br /> requirements of the t'ollo%�ing 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 tiled.and located within 200 feet of the proposed affected area have been identified in this application <br /> (Section 34-32.5-115(4Xe).C.R.S.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law <br /> (Section 34-32.5-1 15(4xt).C.R.S.: <br /> 3. As the applicant/operator.I do not have any extraction/exploration operations in the State ofColorado 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. 1 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 /> T his form has been appromd bt•the 3fined Land Reclamation Board pursuant to section 34-32.5-112,C.R.S.,of the Colorado Land <br /> Reclamation:t c t for the fxtraction c f Construction.4faterials. .-I nt-alteration or mt►diftcation of titis fornt shall result in►v►iding am <br /> permit issued on the altered or nuulifred funs and subject the operator to erase and desist orders and ci►d penalties for operating <br /> ►►vNiout a permit punna►it to section 34-32.5-123.C.R..S, <br /> Signed and dated this day of— lQ�5L1f�_ <br /> �n Cr►.�o �r>s dus7r�r'�-�lLT If Corporation Attest(Seal) <br /> plicant/operator or Compaw"N.i c <br /> Signe Signed: -`-� <br /> Corporate Secretary or Equivalent <br /> Title: "Town/City/County Clerk <br /> State of <br /> )ss. <br /> County of LZL4,a� ) <br /> The foregoing instrument <br /> Awas acknowledged before me this day/o�f <br /> oZD�.by_ .SOji b (-d h �i fi as�'l.,i.w/ o/n!�'a !"Aw a dPi of jr� �J�M�tC Cyr,is <br /> V /�r�/yam/y��`��L✓�V�Q. , °�'�` . <br /> �1S Notary Public <br /> S (;ULORADO <br /> NOTARY 1019f)W2156 My Commission expires: <br /> MYC0h1MtM0NEXPIRESMAR+^u, —1- <br /> SIGNATURES MUST BE IN BL[ . INK CONNIE N DAVIS <br /> Nr- < < nt 1C <br /> You must post sufficient Notices at the location of the proposed mine site o clearly identify the,s the I ation of a <br /> !' _y 'AiNt WIRES MARCH T 7 <br />