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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 /> I. 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 within200 feet ofthe proposed affected area have been identified in this application <br /> (Section 34-325-115(4)(e),C.1LS.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by law <br /> (Section 34-325-115(4)(f),C.RS.; <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 Boardpursuant to section 34-32.5 II2,CR.&,of the Colorado Land <br /> Reclamation Actfor theExtractlon of Construction Materials Any alleradon or modification ofthis form shaII 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 34-32: -123,GRS <br /> Signed and dated this 102APtx' day of a,&\ V�- l' <br /> L L <br /> If Corporation Attest(Seal) <br /> Applicant/Operator or tompany Name <br /> Signed ,J �--� Signed: <br /> Corporate Secretary or Equivalent <br /> Title: Z Town/City/County Clerk <br /> State of C(3 f 0 r6kJ D ) <br /> )ss. <br /> County of e S 0\ ) <br /> The foregoing� instrument was acknowledged before me this Z day of_ BTU 1 N <br /> ZGZ2,by V 1 C9 UV Q,t-Gyru as _ U iiyn P.Y of_ - <br /> KANDICE DEAN WEST <br /> NOTARY PUBLIC <br /> STATE OF COLORADO No C <br /> NOTARY ID#20224022430 <br /> My Commission Expires June 7,2026 M - .rye �Z/ <br /> y Commission expires- �}I (� <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 />