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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)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 I 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 v.� any <br /> permit issued on the altered or modified form and subject the operator to cease and desist orders and civil pena , r(g�e <br /> without a permit pursuant to section 34-32.5-123, C.R.S. �;.••••••. <br /> ���•QORgr�.•A <br /> g 1Zt day of ✓t/� Q•' <br /> Signed and dated this vl ZO �: ;C) <br /> sg' Pao <br /> oldC45 <br /> wG �v la : : <br /> �I t S i' �� c If Corporation Attest(Seal O ••COLO�.• <br /> Applicant/Opera or Comp Name <br /> Signed: Signed: <br /> Corporate Secretary or Equivalent <br /> Title: 5 _ S��7�''y IlP Town/City/County Clerk <br /> State of �j61or&Ito ) <br /> ss. <br /> County of /"t,tS 6, <br /> The foregoing,n,ins''tru--ment was acknowled ed before me this/ k�` day of <br /> by 4&r JI as V(Ct. ei(-c iPJJ of ad �-w5vo �( <br /> d. 1;�� <br /> TRACY A. STATES Notary Public <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20064045541 My Commission expires: <br /> My Comm=*n EWm November 6,2022 <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 />