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-6- <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements of <br /> the following terms and conditions: <br /> 1. All necessary approvals from local government have been applied for(Section 34-32.5-11 l(1)(a)(IX)); <br /> 2. This entire mining operation will not affect more than 30 acres; <br /> 3. This mining operation will not adversely affect the stability of any significant,valuable and permanent man-made <br /> structure(s)located within two hundred(200)feet of the affected lands. (However,where there is an agreement between <br /> the applicant/operator and the persons having an interest in the structure that damage to the structure is to be compensated <br /> for by the applicant/operator(Section 34-32.5-115(4)(e),C.R.S. 1984,as amended),then mining may occur within 200 feet. <br /> Proof of an agreement must be submitted to the Office prior to the decision date.) <br /> 4. 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. 1984,as amended); <br /> 5. As the applicant/operator,I do not have any mining/exploration operations in this 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. 1984, as amended)as determined through a Board finding. <br /> 6. 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. 1984,as amended. <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-111,C.R.S., of the Colorado <br /> Land Reclamation Act for the Extraction of Construction Materials. Any alteration or modificati %t jW14Vf rm shall result in <br /> voiding any permit issued on the altered or modified form and subject the operator to cease anr(.A� if�B9dFivil penalties <br /> for operating without a permit pursuant to section 34-32.5-123, C.R.S. A <br /> �.`Gc;•'PPo > <br /> co <br /> O 9 0� <br /> 1st August 2022 = :� <br /> Signed and dated this day of SEAL <br /> 1985 <br /> Jalisco International, Inc. ; ' •.•oo;� <br /> If Corpaf,�tioi• dal <br /> Ap 'c t/ a tet* o�N <br /> B By: <br /> President Corporate SettntyClerk <br /> y or Equ' alent <br /> Title: Town/Ci <br /> State of Colorado ) <br /> ss. <br /> County of Adams ) <br /> The foregoing instrument was acknowledged before me this 1st day of August, 2022 <br /> f <br /> by Richard Ledezma as President of Jalisco International) Inc. <br /> KACIE SANCHEZ CASTANON <br /> NOTARY PUBLIC <br /> STATE OF COLORADO N u i <br /> NOTARY ID 20224000267 <br /> MY COMMISSION EXPIRES JANUARY 04 2026 My Commissi expires: �� <br /> SIGNATURES MUST BE IN BLUE INK <br />