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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 determined 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 forin 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 thus form shall result in voiding any <br /> permit issued on the altered or inodifred form and subject the operator to cease and desist orders and civil penalties.for operating <br /> without a permit pursuant to section 4-32.5-123, C.R.S. l <br /> Signed and dated this day of S� IbP/ , ava <br /> IHC Scott, Inc. If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> NINNNNIIN <br /> Cott, � <br /> Signed: Signed: C IORA, .�' <br /> Cor or�f orEgtivalent <br /> Title: /W`reif 1_1'4N.46469 Cojy Clerk <br /> State of�'__ Oi ►' �� ) NN1N11111141\\\\� <br /> ) SS. <br /> County of ) <br /> The foregoing instrument was acknowledged before me this day of Y� <br /> .4 j)40 as " of <br /> i <br /> 4atuib <br /> Peggy L ShermanNOTARY PUBLIC li <br /> STATE OF COLORADO e <br /> NOTARY ID2ooaaDe,:em My Commission expires: j <br /> MY COMMISS+ON EXPIRES December 30,2023 <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 />