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-7 - <br /> Certification: <br /> As an authorized representative of the applicant,I hembv certify that the operation described has met the minimum requirements <br /> of the following terms and conditions: <br /> I. To the best of my knowledge,all significant,valuable and permanent man made strucu*s)inexistence 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(4xe),C.R.S.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32.5-115(4xf), <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 /> 34-32.3.120,C.RS)as determined through a Board futding. <br /> 4. 1 understand that stateaments in the application are being made under penalty of perjury and that false statmwts made <br /> herein are punishable as a Class l misdemeanor pursu t to Section 18-8-503,C.R.S. <br /> Signed and dated this day of Q "' <br /> V4 If Corporation Attest(SCSI' <br /> Applicant/ t os Camp <br /> Signed: Signed: <br /> Corporate Secretary or Equivalent <br /> Title: / Town/City/County Clerk <br /> State of G'v/O/'add _ 1 <br /> County of r7Qwa'/a1/ 1 <br /> The foregoing instrument was acknowledged before me this day of 5eO�Om 6'e r _ O <br /> by tt=A&fV� .S7/P 1 'aVS-O r7 as U:�� s n y of Q�ar%it4 to�`1C ��SdurCG5. <br /> h. <br /> ?V -'Public <br /> i <br /> My Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />