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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;s filed,and located within 200 feet of the proposed affected area have been identified in this application <br /> (Section 34-32.5-1 15(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 of Colorado currently in <br /> violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Matt.rials <br /> (Section 34-32.5-120,C.R.S.)as determined through a Board findin;.. <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 I misdemeanor pursuant to Section 18-8-503.C.R.S. <br /> This form has been approved by the boned Land Reclamation Beard pursuant to section 34-32.5-112,CR.&,of the Colorado Land <br /> Reclamation Acrfor the Extraction of Construdion Materia& ,any alteration or motllfleation ofthis 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 fur operating <br /> without a permit pursuant to section 34-32.5-IIJ.CRS <br /> tt `\\\\,\,117 ft 71P7/PPP/ <br /> GONCRj:. <br /> Signed and dated this dayof <br /> 3"p OR,q F' <br /> N1s ,��- • 'tom����t e. L �= GSEALF o- <br /> V • If Corporation Attest(Seab>-: ; x <br /> Applicant/ rotor or Company Name =0. .mar <br /> eL <br /> Sig Si ned: <br /> Title_ Y1N—L' Corporate Secretary or Equivalent <br /> i'' Town/City/County Clerk- <br /> State of j,J to(j. L C t <br /> County of <br /> The foregoing.instrument was acknowledged before me this day of Vt <br /> iL- by ZlZ2DAr,Skr _as Mori-;A C ( of NtIk{ Ccy)crcd-� <br /> IAURA K ELDREDGE <br /> NOTARY PUBLIC-STATE Cr COLORADO ' Notary Public <br /> Notary Identification#20154035975 <br /> j t•Ay Commission Expires 9l1-012--019 C Ci <br /> My Comm Viss.on expires: f <br /> SIGNATURES MUST BE IN BLUE INK <br /> You mw,st post sufficient Notice, at the location of the proposed mine site to clearly identify the site as the location of a <br />