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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. 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. <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 thisform 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 R day of A p f I I 2 U Z Z <br /> Flintstone Gravel Pit Tnc. ��`� GFR If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name S�0"!• pp <br /> i SEAL`�Z �-o _ <br /> Signed: � � NCO`o 2021 Q y: Signed: LLA=:L�_ <br /> .0 ,p Q•; <br /> ;2j ORP.��;' Corporate Secre or Equivalent <br /> Title: President J��i, Town/City/County Clerk <br /> State of ( 1U1Ad U ) <br /> SS. <br /> County of 6 ay) ) <br /> The foregoing instrument was acknowledged before me this _day of �1 <br /> by J V uL lk)C kG�f�.v J,6 (�11c WAVt P(-eS. A,-J o�SecrLAM of i n j}O,�C a,of� T✓1r_ <br /> EMILY BORN <br /> NOTARY PUBLIC Notary blic <br /> STATE OF COLORADO ry <br /> NOTARY ID 20084029323 <br /> FLMiyCMISSION EXPIRES SEPT EMBER 8 2024 My Commission expires: <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 />