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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)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)(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 penalties for operating <br />without a permit pursuant to section 34-32.5-123, C'.R.S. <br />Signed and dated this cQS'' day of G Libie— oat f . <br />61A P-(4-1RA If Corporation Attest(Seal) <br />Applicant/Operator or Company Na i <br />Signed: ... I ) - <br />1 — Signed: <br />P'",IV <br />Corporate Secretary or Equivalent <br />Title: President Town/City/County Clerk <br />State of eAplr ,c <br />ss. <br />County of isr c <br />The foregoing instrument was acknowledged before me this day of <br />by ZSo\ .P. as Prtblkt.Vlk of 6Pltit11_ W i 3. <br />4.ga t i11i <br />JODI D SCHREIBER <br />tea 1,_,.),' <br />NOTARY PUBLIC.STATE OF COLORADO Notar ublic <br />My Identification#20064001792 <br />Expires October 6,2018 ithMyCommissionexpires: AAP <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