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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 this form 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 1 7II' day of d61.1•t.IA42,vti , 00 XII . <br /> JcQ . PALL. lat,u . A. ° ; .- '` , ' ►vtnk Lit. If Corporation Ar - t(Seal) <br /> Applican • %erat•r o Cs', pany Name _ i <br /> Signed: AI t �__ _ Signed: A. ,. <br /> Corpo Se.,t -• <br /> Title: PresidentIv Town/Ci y County Clerk <br /> State of Cp i 0►-,r,_d o ) <br /> //�� )ss. <br /> County of `tt.LL L Li ) <br /> The foregoing instrument was acknowledged before me this 17 day of jAvL aA.t , <br /> 4:24:21g±, by qt,ALir 4 44 rti as weal c_(yrt of Na.p.tt 14Vi `(ad i V1.1,.1t <br /> Iae. <br /> C --..1- e____i. >,.. . <br /> I-JODI D SCHREIBER Not'. ! blic <br /> NO`V"ARY PUBLIC <br /> STATE OF COLORADO <br /> N01,-AY ID 20064001792 My Commission expires: t l b/'G <br /> MY COMMISSION EXPIRES OCTOBER 6,2026 <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 />