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-6- <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements of <br /> the following terms and conditions: <br /> 1. All necessary approvals from local government have been applied for(Section 34-32.5-111(1)(a)(IX)); <br /> 2. This entire mining operation will not affect more than 30 acres; <br /> 3. This mining operation will not adversely affect the stability of any significant,valuable and permanent man-made <br /> structure(s)located within two hundred(200)feet of the affected lands. (However,where there is an agreement between <br /> the applicant/operator and the persons having an interest in the structure that damage to the structure is to be compensated <br /> for by the applicant/operator(Section 34-32.5-115(4)(e),C.R.S. 1984,as amended),then mining may occur within 200 feet. <br /> Proof of an agreement must be submitted to the Office prior to the decision date.) <br /> 4. 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. 1984,as amended); <br /> 5. As the applicant/operator,I do not have any mining/exploration operations in this 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. 1984,as amended)as determined through a Board finding. <br /> 6. 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. 1984,as amended. <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-111,C.R.S.,of the Colorado <br /> Land Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in <br /> voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties <br /> for operating without a permit pursuant to,section 34-32.5-123,C.R.S. <br /> / <br /> Signed and dated this 3 Yd day of T p r.c I a o • <br /> A- Pc SoLZ-4 w, Co s i V u cT` c c, LLC. If Corporation Attest ' -al) <br /> Applicant/Operator <br /> Byctwy‘.$26- <br /> / / Corpora e Secretary it Equivalent <br /> Title: V L`C e I''v e S t ct e Town/City/Co > y Clerk <br /> L ) <br /> State of (1 � <br /> ss. <br /> County of J ) <br /> The foregoing instrument was acknowledged before me this 7) day of <br /> '� L (� ,� r n Care c- aon C.L " <br /> by�(`(1P�1►1 t(�(��11,GL�,I� as 1 C.2�G�ts1�� of <br /> TERESE VIRGINIA LOMBARD - <br /> Notary Public /�,,� WI1/4n-J �i j. <br /> State of Colorado '"D' tt111111 <br /> Notary ID#20194005945 Notary Public <br /> My Commission Expires 02-12-2023 <br /> My Commission expires: Z1 1—4)-0 <br /> SIGNATURES MUST BE IN BLUE INK <br />