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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 /> I. To the best of ms 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 he located on lands where such operations are prohibited by law <br /> (Section 34-33.5-I 15(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 (:and Reclamation Act for the Extraction of Construction Materials <br /> (Section 34-32.5-120.C.R.S.)as determined through a Hoard 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 I misdemeanor pursuant to Section 18-8-503.C.R.S. <br /> This forst has been approved hr the Alined Land Reclamation Board pursuant to section 34-32.5-!i2,C.R.S.,of the Colorado Land <br /> Reclamation.-Iet 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 ! %\ day of ( rl I11.? . <br /> t. <br /> el.)1z, ti, (t ( (tr 1117( (rt,, c 1 1,f' <br /> I f Corporation Attest(Seal) <br /> Applicant'()perator or Company Name <br /> 17, <br /> Signed:/ � , ' �,� 't,'L C Signed: <br /> c� Corporate Secretary or Equivalent <br /> (� <br /> Title: C Ll✓1, C f'^ �t l <br /> fuscniC'ity!County Clerk <br /> 1 <br /> State of <br /> ss. <br /> County of rr('n'1 D <br /> The foregoing instrument ssas acknowledged before me this I( iftt day of Jai/an (-Li <br /> q(),;9. by AA 1`0,' l(fca i I i ' as (j t1'6 •°.�(' .5'f�, tr. -cirri of e,..4 ru d //44 i"li t"5 <br /> virs.abasb <br /> ` LINDA CASEY <br /> 4 NOTARY PUBLIC-STATE OF COLORADO 1 Notary Public <br /> NOTARY ID 20184002983 . <br /> MY COMMISSION EXPIRES JAN 18, 2026 ( J � <br /> My Commission expires:, ,]%l(,C'(�(t( 1 (..- 6.21•6' <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 />