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-8- <br /> As an authorized naive of the applicant, I hereby certify that the operation described has met the minimum <br /> requireameuts of the following terms and conditions: <br /> 1. To the best of my knowledge,all significant,valuable and permanent man-made structures)in existence at the time <br /> this application is filed,and located within 200 feet of the proposal affected area have been identified in this application <br /> (Section 34-32.5-I 15(4xe),C.R.S.). <br /> 2. No mining operation will be looted on lands where such operations are prohibited by law <br /> (Section 34-32.5-115(4X4 C.R.S.; <br /> 3. As the applicant/operator,I do not have any extraction/exploration:operatimrs in the State ofColormdo=ready 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. 1 understand that statements in the application are being made under penalty of perjury and that false sta�s <br /> made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S. <br /> Thin form has been approved by the Mbud Land Redwnation Board pursuant to wc&x 34 32.5-112,GRA,of the Colwv&Land <br /> Rec Orr Ad for the lion of C0m&Ncd"Mom. ANY o/laraden or sr9 fm ef&h fwm ahem rMlt in voh any <br /> peraW leaned on the altered or n q*W form and srrbjed the gperator to eerie and d=W m*aa and dvil pexodtw for'WAIMW <br /> wdJww apmw pursumIt to sedkn 34 32S-123,CRS <br /> Signed and dated this.j. W 3 day of Ann ep r� <br /> O]Ce* 2 M �,r r'a ,��r.e u _ st,,,,,� �, If Corporation Attest(Seal) <br /> ApplicanWpera W or Company Name <br /> Signed: Signed: <br /> ,�1 Corporate Secretary or Equivalent <br /> Title: ..,aa 4*416,"- Town/City/County Cleric <br /> State of t I`,( A 1 <br /> County of. Kt l i(1� ) ) _ <br /> The foregoing instrument was acknowledged before me this�?� day of /)Fit11� <br /> as Of <br /> R S 1 <br /> JIL - <br /> MASTERS-NOTARY PUBLIC <br /> STATE OF COLORADO <br /> >'r}TARY ID t 199740109p <br /> '"rPIRES JI1•1 My Commission expires: I� <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 />