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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)inexistence at the time <br /> this application is tiled,and located within 200 feet of the proposed affected area have been identified in this application <br /> (Section 34-32.5-1 15(4)(e), C.R.S.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law <br /> (Section 34-32.5-1 15(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 I misdemeanor pursuant to Section 18-8-503,C.R.S. <br /> This form has been approved hy 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. Anv alteration or modification of this form shall result in voiding all, <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 /> ` 7ti <br /> Signed and dated this 1 day of Jar Logr L\ <br /> Connell Res es, Inc. 1 I i <br /> ♦% 10cr oration Attest(Seal) <br /> Applicant/O erator r Company Name `♦♦`01kc �� / <br /> 0 OF <br /> dop <br /> M <br /> .'0046 <br /> �►�• A1►TE •''• ' <br /> + <br /> Signed: "`�"-- � ,� S�:gned" <br /> Rc!.'orate Secretary or Equivalent <br /> V <br /> President <br /> Title: i �• <br /> �' 0 •�••�••••. Town/City/County Clerk <br /> State of co O racAu <br /> ss. <br /> County of I <br /> The foregoing instrument was acknowledged before me this day of JQn UQ r u <br /> by -inn as f'tYS`(idetTt of <br /> 7----JENNIFER LINDBLAD Notary Public <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20144008302 My Commission expires: ` <br /> MY COMMISSION EXPIRES FEB.21,2022 <br /> SIGNATURES MUST BE iN BLUE INK <br />