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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 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 detennined 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 Boardp cant 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 permitpursuant to section 34-3Z5-123, C.R.S. <br /> Signed and dated this G day of � 2 0 Z <br /> l y N y /;�"��✓S If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed: 4�� �i Signed: <br /> Corporate Secretary or Equivalent <br /> Title: /� �!'/r � �'' Town/City/County Clerk <br /> State of LO <br /> ss. <br /> County of arc ,NEE�'Z ) <br /> The foregoing instrument was acknowledged before me this �J day of v�'�c , <br /> 20ZZ, by A as !2lif'w ytz'- rAI-V-01i of VV'10 1Y.v>r LL <br /> RYAN LEATHLEY <br /> NOTARY PUBLIC <br /> STATE OF COLORADO is <br /> NOTARY ID 20174024398 <br /> MY COMMISSION EXPIRES J U N E 8,2025 L� <br /> My Commission expires: (0(-�k CC <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 />