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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 rnan-rnade 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. 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 voi ft,any <br /> permit issued on the altered or modifred form and subject the operator to cease and desist orders and civil pens ti s BiCg p�e� ` <br /> without a perrnitpursuantto section 34-32.5-123, C.R.S. ?.••�••• �,q <br /> �G <br /> Signed and dated this l2 day of tf��ti ZO �C7 <br /> Qlo(c-45�/'c 5 w �ar���, �� C If Corporation Attest(Seal COLO�U� <br /> Applicant/Opera or Comp Name <br /> Signed: Signed: <br /> Corporate Secretary or Equivalent <br /> Title:1451- s�/�I�'2f / Vp Town/City/County Clerk <br /> State of <br /> ) <br /> County of P'n ss. <br /> The foregoing instrument was acknowled ed before me th1is/ k�` ,,d-a4ty,of .J , <br /> by 4&r • J1 tel as V(C4 Pi(-ZG f 0 of <br /> TRACY A. STATES Notary Public <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20064045541 My Commission expires: <br /> My Commission Expires 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 />