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Certification: <br /> As an authorized representative of the applicant,I hereby ow*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 this <br /> 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.RS.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32.5-115(4)(0, <br /> 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(Section <br /> 34-32.5-120,C.R-S.)as determined through a Board finding. i <br /> 4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br /> herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S. <br /> Signed and dated this D / day of ` �[�►T_ zoo <br /> 1x If Corporation Attest;(Seal) - <br /> Applicant/ Pm <br /> C a <br /> Signed: I� Signed' <br /> C Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> 10 <br /> State of (. — <br /> County of Z x�; ,�)ss <br /> The foregoing insdvment was acknowledged before me this 7/ day of (�, o o /, <br /> by of Z�El��ZE _.y,.r <br /> Nc Public <br /> My Commission expires: ®, a R <br /> SIGNATURES MUST BE IN BLUE INK � - <br />