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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 permitpursuant to section 34-32.5-123, C.R.S. �•o`••�ga 1�-1�'ve���''•,, <br /> Signed and dated this_ day of �G�.v�G'Ir �lU I : �G ��ed•� ����' <br /> If Corporation Attest(Scal) ..�2012 <br /> Applicant/Operator or Company Name z, �o <br /> !awa. <br /> • <br /> Signed: Signed: <br /> c A�� <br /> Corporate S cretary or Equivalent <br /> Title: �n U Town/City/County Clerk <br /> IJ <br /> State of <br /> ss. <br /> County of <br /> tk <br /> The foregoing instrument was acknowledged before me this day of Jam' ✓1 c�,c��rrc�I , <br /> D/yby 1"YZ(C"�p/ Q�e_ as �t1�I(f�rnr hf4� V of .�� �� LI&B, LLC� <br /> ••�,+V P��/i VICKIE SUZANNE LOSOYA " <br /> Notary Public,State of Texas Not ubhE <br /> �' Comm. Expires 02-28-2022 <br /> '�i„��W• Notary ID 131489738 c/ <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 />