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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(4)(Q. 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, 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 by the bilned Land Reclamation Board pursunut to section 34 32.5-111,CR.S, of lite Colorado Land <br />Reclamallon Actfor the Extraction of Cotrstritctiott Afaterials. Any alteration or mod!frcation of this form shall result in volding any <br />permit issued on the altered or modffled farm and subject the operator to cease and desist orders and civil penaldes jar operating <br />without a permit pursuant to section 34-32.5-113, CR.S. <br />Signed and dated this Q day of '11�_fC.T.NIN`nng-'c-_ _.4 { <br />h _ 0� If Corporation Attest (Seal) <br />Applicant/Operato r Company Name } <br />Signe�___ Signed: <br />Corporate Secretary or Equivalen <br />Title: Road Supervisor -T*wnWA;yqCounty Clerk <br />State of Co to ra d o <br />County of 7Z�ln <br />The foregoing instrument was acknowledged before this g94A day of1p-Lbw'_ r <br />Qf/ , by as _ Of If- r/t �Gl 11 ti <br />DEBRA S. COWAN vt _ <br />NOTARY PUBLIC Notary Public <br />STATE OF COLORADO <br />NOTARY ID 20414039846 <br />MY COMMISSION EXPIRES DECEMBER 21, 2017 <br />My Commission expires; D:. cernL - ,,;; ,,'0/7 <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 />