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-8- <br />Certifi tion: <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 ofmy 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)(fl, C.R.S.; <br />3. As the applicant/operator, I do not have any extractiontexploration 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 Boardparsuant to secdon 34 3T-S:II$CJLS, of the Colorado Land <br />Reclamadon Act for theBxtracdon of Construction Material& Any alteradon or modijlcadon of thisform shall result in voiding any <br />permit issued on the altered or modffled form and subject the operator to cease and desist orders and civil penalties for speradng <br />without a permitpursuant to section 34-325-123, C1LS. <br />Signed and dated this 3l 37- day of C2CM CJ2 . ;1o/7 . <br />Title: DI R rMow 0F4lrIL1Tl- <br />K Corporation Attest (Seal) <br />&& 11 <br />— <br />Signed: Lu et <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of cowc- a-0 ) <br />} ss. <br />County of <br />The foregoing instrument was acknowledged before me this day of. , <br />.f , by V as Dre0y t 5 of LA4. ek &iVAQ_ <br />NOTARY PUBLIC No public <br />NYD7351 <br />TARI00340169 <br />IMYCOMMISSION EXPIRES JM=19 <br />My Commission expires: 1 `} <br />SIGNATURES MUST BE IN BLUE INK <br />