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-5- <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements <br /> of 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 <br /> between the applicant/operator and the persons having an interest in the structure that damage to the structure is to be <br /> compensated for by the applicant/operator(Section 34-32.5-115(4)(e), C.R.S.), then mining may occur within 200 <br /> feet. 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(Section 34-32.5-115(4)(f), <br /> C.R.S.); <br /> 5. As the applicantloperator, 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.)as determined through a Board fording. <br /> 6. I understand that statements in the application are being made under penalty of perjury and that false statements made <br /> 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 34-32.5-111, C.R.S., of the <br /> Colorado Land Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form <br /> shall result in voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders <br /> and civil penalties for operating without a permit pursuant to section 34-32.5-123, C.R.S. <br /> Signed and dated this 3D-A. day of 14 ydw ?Z20 <br /> 1cc�tuw.4J'YL►� O) � If Corporation Attest(Seal) <br /> Applicant/Operator <br /> ABy: 4By: <br /> Corporate Secretary or Equivalent <br /> Title: /`ic3'>agel' Town/City/County Clerk <br /> State of (.o"46 ) <br /> D )ss. <br /> County of R 7dro ) <br /> The foregoing instrument was acknowledged before me this 59'� day of Akycmhe/ 2t920 <br /> by 5rtieM as ./4AM94e - of Lb � aMy <br /> (Name) e) licam/Opera <br /> DAVID LIEBMANN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO Notary lic <br /> NOTARY ID 20184039073 <br /> F <br /> COMMISSION EXPIRES OCTOBER 3,2022 <br /> My Commission expires: 10 �O <br /> SIGNATURES MUST BE IN BLUE INK <br />