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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)inexistence 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,G.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 farm has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.R.S,of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or mvdriJlcadon of thisform shall result in voiding any <br /> perndt issued on the altered or nwdifled form and subject the operator to cease and desist orders and chit penaldes for operating <br /> without a permit pursuant to section 34-32.S-123,C.R.I <br /> Signed and dated this _day of da of FF Y-<<(E i:i <br /> �XCA It 16,u ,6A iku ,,. ( If Corporation Attest(Seat) <br /> Applicant/Operator or Company Name <br /> Signed: 41 Signed: <br /> C Corporate Secretary or Equivalent <br /> Title: a.n. wl ,.0 A LA,,," Town/City/County Clerk <br /> State of '0 I Lt <br /> ) <br /> )ss. <br /> County oA d N I r`O ("s ) <br /> The foregoing instrument was acknowledged before me this+ day off 4r4 0, <br /> .byJ(irjst`i C11Ct-trrr ['.� as 7 of ; � 'i i �r A <br /> A <br /> JILL MASTERS Notary~~blic <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> :NARY IO•f097401W <br /> ^vDIRES iw My Commission expires: <br /> SIGNATURES 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 />