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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)(f), 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. I 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 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 modification of this form shall result in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penal ' g <br />without a permit pursuant to section 34-32.5-123, C.R.S. �? .......OG <br />Signed and dated this 1A, day of�%/r <br />b!c�c� s f le S W �Yv�rp, Tic- <br />� <br />A, t-ec� ova, -? f l 1 e s <br />Applicant/Operator or Company Name <br />Signed: <br />Title: <br />State of i� roy ) <br />ss. <br />County of `� �S q ) <br />If Corporation Attest <br />��•�BORAT�:A <br />C: O :2 <br />Q•U ' C7 <br />00. <br />O <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this day oftt-TV k ell <br />1 <br />by E�P/�, n_P as of P/W'�sf% StO6,vua.T c . <br />GENEVIEVE'M.BLECHA J cl6q l o'► � <br />NOTARY•PUBLIC �� QAkP d ,,,L <br />STATE OF COLORADO Nota Public <br />NOTARY ID #1014003259 Notary <br />i 4 commission Expiros April 4, 2019 J <br />My Commission expires: ita✓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 />