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-8- <br /> Certificabon: <br /> As an authorized representative of the applicant, I hereby certify that the operarion described has met the minimu� <br /> recNi�'etn�7tt��f�he�ollowing term,s and conclitions: <br /> 1. To the best of my knowledge,all significant,valuable and permanent man made struct�re(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 /> {Seetivn 3�-32.5-1 IS(4)(e),C.R.S.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law <br /> {Sectio�3432.5-115(4)(�},C.1t.S.; <br /> 3. As the applicandoperator,I do not have any extraction/exploration operations in the 3tate�f Colorada�urrently in <br /> violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br /> (Section 3432.5-120,C.R.S.}�s d�termined through a Board finding. <br /> 4. I understand that statements in the application are being made under penalty of perjury and that false statements <br /> mad�herein are punishable as a Class 1 misdeme��a���rsuant to Section 18-8-SU�,�.R.S. <br /> This farm hQs been qpproyed by the M-u�td Land Reclanaation Boardpursttent te se�tean 3�325 Ii2,CRS,of ihe Colarawto Land <br /> Reclanration Aet for the EztriYcteon of Constructrion Material� Any alteration or modiftrotiun of ihis fortn shall result in voidirtg any <br /> penttit issued on the altered er modefred form and subject tl��operator to cease and d�sist orders and civil penalties for operating <br /> without a pernritpursuunt to section 34-32.5-123, C.RS. <br /> Signed and dated this�day of ��� �?� <br /> 1,7�-� SS � � �c-..�-� �-o-,.��-(, <br /> � <br /> �� If Corporation Attest(Seal) <br /> ,n r� s.� ,. <br /> A�pli�antlOperato � % y l�ame <br /> � <br /> Signe • ' � - - <br /> S' <br /> Co rate Secretary or quivale t <br /> Title: � �`� � ��,��r� ToyynlCity>Coun Cierk <br /> � <br /> State of ���r,�d� � <br /> )ss. <br /> County af � ��r/ � <br /> The foregoing insirument was acl�owledged before me this� ��_day af ���r� <br /> ���'�y � of <br /> Andrew Robert Zuercher <br /> NOTARY PUBLJC Notary�u�l'tC <br /> STATE OF COLORADO <br /> NOTARY ID 20154D24399 � <br /> MY COMMISSION EXPIRES September 20 2023 My Commi�ion e���es: �I�i � <br /> SIGNATURES�'IUST BE IN BLUE INK <br /> You must post sufficient Notices at the location of the proposed mine sitc to cl�arly ide�tify�ie site as the location of a <br />