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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)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 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 voiding any <br /> permit issued on the altered or modified form 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 Q 4 day of J !AN4_ 0�2 <br /> 1 If Corporation Attest(Seal) <br /> Applicant/(*erator or C&npany Name <br /> C; J o J� l_c. <br /> Signed: ..••"•'•"'%*%�j. ined: L, <br /> f�pME RU� �'� Corpora ecretary or Equivalent <br /> Title: Town/City/County Clerk <br /> C) .0 <br /> s: Ilk <br /> State of Cc> lC . '•••.........••••• <br /> County of ss. COU U6 U <br /> The foregoing instrument was acknowledged before me this e.,74 4` day of­':YLnt , <br /> .Cl ,byaol.. e.�linc as�� C:l,,, �alr►-►�n���it�r of C:�,., o-C <br /> SUSAN BARKER Notary Public <br /> Notary Public <br /> State of Colorado <br /> Notary ID#20034035639 wima, mission Ex Irea 10-20.2023 My Commission expires: o� <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 />