2019-03-18_PERMIT FILE - M2018051

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q16A I (� RECEIVED MAR-1 8 2019 Certification: DMSION OF RECLAMATION -• MINING AND SWETY As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following terms and conditions: 1. To the best of my knowledge,all significant,valuable and permanent man-made structure(s)in existence at the time this application is filed,and located within 200 feet of the proposed affected area have been identified in this application (Section 34-32.5-115(4)(e),C.R.S.). 2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(0,C.R.S.; 3. As the applicant/operator,I do not have any extraction/exploration operations in the State of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120,C.R.S.)as determined through a Board finding. 4. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S. This form has been approved by the Mined Land Reclamation Boardpursuant to section 34-32.5-112,C.R.S.,of the Colorado Land Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34-32.5-123, C.R.S. (� Signed and dated this I I day ofmojub?))a Ck, MLWia iASM6 If Corporation Attest(Seal) Applicant/Operator or Company Na Signed: Signed:N�_J Corporate Secretary or Equivalent Title: •�It )�b� Town/City/County Clerk State of �iC'I,O�1� ) )s. County of, The foreg/i in tr-uCment as acknowledged before me t 's day of , 0A- by l ICJ J �CSS as S of (1NUC BRYANNA ARROYO LOCKHART° P' Notary ID#131701504 Not My Commission Expires F�F tE August 28, 2022 p, My Commission expires: SIGNATURES MUST BE IN BLUE INK You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a