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-8- <br /> CertificxHon: <br /> As an authorized rcprovIltatiyc 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 structures)in existence at the time <br /> this application is filed,and located within 200 feet ofthe proposed affected area have been identified in this application <br /> (Section 34-32.5-1 15(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 Reelartration Act for the Extraction of Construction Materials <br /> (Section 34-32.5-120,C.R.S.)as determined through a Board finding. <br /> 4. t 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,CKS. <br /> 77sis form has been approved by the Mined band Reclamation Board pmrsuant to section 34-325-112,C RS,of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or mods,fcadon of thisform shall result in voice any <br /> permit issued on the altered or modified form and subject the operator to cease and desist orders and dvil penalties for operating <br /> without a permit pursuant to section 34-32,5-123,GR.& <br /> Signed and dated this� day ofc�.� <br /> Deep Cut LLC If Corporation Attest(Seal) <br /> Applicant/ r Company Name <br /> Z <br /> Signed: Signed NA <br /> Corporate Secretary or Equivalent <br /> Title: owner Town/City/County Clerk <br /> State of_ Colorado ) <br /> )ss. <br /> County of otero } <br /> The foregoing instrument was acknowledged before me this day of <br /> by Chris Tomky as E?wner of-0M <br /> TONI JO PULLARA <br /> NOTARY PUBLIC 1dOtg Public <br /> OF COLORADO Notary <br /> NOTARY ID X 20104004805 <br /> MY COMMISSION EXPIRES FEBRUARY 11.2018 <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 />