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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 />I. 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 arc prohibited by law <br />(Section 34-32.5-115(4x!), C.R.S.• <br />3. As the applicantloperator, 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 farm has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.R.s, of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials Any alteration or modlficallon of thisform shall result in volrling any <br />permit Issued on lite altered or modijled form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-32.5-123, CR.S. <br />Signed and dated this - Ig 74' day of ►M Ay2C.l4 Lc71 i <br />Applicant/Operator or Company Name <br />Signed: <br />Title: Qct!'_ L1Lgy` <br />State of <br />)ss. <br />County ofd/� 1 <br />If Corporation Attest (Seal) <br />Signed: (6 <br />Corporate Secretary or Equiva t <br />Town/City/County Clerk <br />The foregoing instrument as acknowledged before me this '� day of AJ14, <br />JjVt by gA e A 4W as of J��4411ZA 6. <br />NOTA.EY PUBLIC Nota Public <br />STATE OF COLORADO Notary <br />NOTARY ID 201 W24401 <br />�N fAMialS51::,V rfi�,t1� ,' .efllL 22. 2M9 <br />.--- My Commission expires: <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 />