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-8 - <br />Certification: <br />As an authorized representdtive of the applicant, 1 hereby certify that the operation described has met the minimum <br />requirements of the follo%N ing terms and conditions: <br />1. To the best of my hno« ledge, all significant. valuable and permanent man-made structures) in existence at the time <br />this application is filed, and located �01fln 300 feet of the proposed affected area have been identified in this application <br />(Section 3=4-32.3-1 15(-4)(e), C.R.S.). <br />3. No mining operation %rill be located on lands %khere such operations are prohibited by la%% <br />( Section ')4-32.5-115(4)(0, C.R.S.: <br />3. As the appl icantioperator. I do not have any extract ioWexploration 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 34-33.5-130, 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 I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This forth kits been approved by the Alined Laird Reclamation Board pursuant to section 34-315-112,C.R.S , of the Colorado Land <br />Reclamation Act for rite E.rtruction of Constructiott Materials. Any alteration or rnodifrcution of this forth shall result in twiditrg airy <br />permit issued an the altered or modifred form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-3? 5-123, C.R.S. <br />Signed and dated this I % t—' day ofd/ / / , �1' <br />1 - <br />Applicant/Operator or Company Name <br />Signed: K10' t . <br />f==::— <br />Title:- CVa;I? r,.PZ_ <br />State of <br />s <br />Countyof Lco A h l w� ) s. <br />IFCorporation Attest (Seal) <br />Signe .' O�k I �- "-, ( . I �'- <br />Corporate Secretary or Equivale t <br />ToHn/City/Ct?unty Clerk <br />The foregoing instrument was acknowledged before me this 1_74'�' day of�jTl <br />1 Mack LLu1�P as 5� h ` <br />�. y t of (�S i�Yl_111/1Q.5 CCL.ZA <br />NOTARY PUBLW Notary Qk <br />STATS OR COLORADO <br />NOTARY W N1740l 3 <br />MYC08101ONNIM>ZZPU=1-1440M My Commission expires: <br />.7 /1qr <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 />