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-8- <br /> Cerlilication: <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. 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 Mixed 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. Axy alteration or xmdifrcation of this form shall result in voiding any <br /> penult Issued on the altered or modified farm and subject the operator to cease and desist orders and civil penalties for operating <br /> without a permit pursuant to section 34-32.5-123,C.R.S. / <br /> Signed and dated this 7 fk day of <br /> Colorado Sand Company LLC If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed: Signed: No Corporate Seal <br /> Corporate Secretary or Equivalent <br /> Tide: Chief Financial Officer Town/City/County Clerk <br /> State of `ILl° 1100 c" 1 <br /> )ss. <br /> County of <br /> The foregoin&instrument was acknowledgedbefore me this�� day of , <br /> by f I t � �,�.� �f'i�t�z7tiv�c :uM1f7vilas <br /> OREHEAD <br /> ERLINOT R M Notary Public i <br /> NOTARY PU�-IC <br /> S-fATE OF COLORADO � <br /> NOTARY ID#199 � o� <br /> Comma ion 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 />