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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 requirements <br /> 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 applicantloperator,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 Hoard pursuant to section 34-32.S-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 operating <br /> without a permit pursuant to section 34-32.5-123,C.R.S. <br /> Signed and dated this 00 I day of 0 eLe r ' xr , aD 0"7 . <br /> �T..---- If Corporation Attest(Seal) <br /> ....,Cat t"4/0 0.- <br /> Applicant/Operator or Company Name <br /> -v C/ <br /> Signed: CO rvt\l ReSC>)rc.�S, �nC.. Signed: (9- (.4..../4...44-1---- <br /> Corporate Secretary or Equivalent <br /> Title: -Tres dkC`nar Town/City/County Clerk <br /> State of Cri tor-a-do ) <br /> )ss. <br /> County of LAX-i'i _LiC ) <br /> The foregoing instrument was acknowledged before me this a s� day of U. L,Crl\la.�r , <br /> diol,by `•VNi chard cA lmvcil. as `s reskdtryk- of Q'DYW tW 12..P,tiSR.-el, T.11‹.. <br /> Y P <br /> JAIJL& A _.1i 10 <br /> 20 �e tary Public <br /> DANA <br /> CREGO l41• •mmission expires: <br /> % :1;.i <br /> SIGNATURES MUST : • ' OE INK <br /> MY COMMISSION EXPIRES: <br /> August 13,2011 <br />