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- 8 - <br /> Certification: <br /> As an authorized representative of the applicant, 1 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. 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 1 misdemeanor pursuant to Section 18-8-503,C.R.S. <br /> This form has been approved by the:tilined Land Reclamation Board pursuant to section 34-31.5-111,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 34-31.5-123,CR.S <br /> Signed and dated this u}h day of S e p+ember• ;2C 1 8 <br /> Weld County Public Works <br /> If Corporation Attest(Seal) <br /> Applicant/Operator ompany Nam <br /> Signed:. 24 r` �°��1 Sign <br /> -7 Corporate Secretary or Equivalent <br /> Title: Director of Public Works i�et Town/City/County Clerk <br /> State of Colorado ) T(�a <br /> )ss. <br /> County of Weld ) ! <br /> The foregoing instrument was acknowledged before me this L4 day of `. �., ,.�4Ci <br /> by Jay McDonald as Director of Public Works <br /> 1Notac Pu lic <br /> No <br /> �Q �>d�-8artvw `• JJ <br /> STATE OF COLORADO My Commission expires: <br /> NOTARY ID 20134WI237 <br /> MYCOMI>�310N F ESIIl QW 1Z 3OZ <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 />