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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 stntcture(s)in existence 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(4)(0,C.R.S.; <br /> 3. As(lie 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 band 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 statements <br /> made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S. <br /> This form has been approved bj,the i1lined Late!Reclamation Board pursuant to section 34-32.5-112,C.R.S.,of the Colorado Land <br /> Reclantatiott Act for-the L.rtractiott of Cotlsh-action jlfaterlaty. Anp alterrttiots or tttodificatiott of Illis forth shall resttlt in voiding attP <br /> permit issued on Ilse altered or modified form and subject the operator to cease and desist orders and civil peuallies for operating <br /> wilhout aperntitpursttant to section 34-32.S-123, C.R.S <br /> Signed and dated this day of J6I aaA!-y e9d/7 <br /> �!/l�,k�ti'1► /1 LP�7 � Z2YlCL�S� If Corporation Attest(Seal) <br /> Applicant/Opel' or Company Name <br /> Signed: Signed: ' <br /> Corporate Secretary or Equivalent <br /> Title: D11/1Stin /©aQd8n-- Town/City/County Clerk <br /> State of 0-0 l D rmdD ) <br /> ss. <br /> County of�a . ofy } <br /> The foregoing instrument was acknowledged before me this day of A h °0/1 , <br /> ,by as p sId'nf of A&k6 Ovr <br /> JULIE M MIKULAS ota�y Public <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 19964009323 My Commission expires: <br /> MY COMMISSION EXPIRES MAY 30,2020 <br /> SIGNATURES MUST BE IN BLUE INK <br /> You must post sufficient Notices at the location of(lie proposed mine site to clearly identify the site as the location of a <br />