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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 r to/ O '�sectio 3 -32.5-123,C.R.SC�`<S� <br /> Signed and dated this /5 day of G 4 . <br /> Tamrock Gravel LLC If Corporation Attest(Seal) NO SEAL <br /> Applicant/Operator or Company Name <br /> "..-24 <br /> �( -•� r�%i���`'tSigned: — '�^''t <br /> Signed: �v / / <br /> Corporate Secretary or Equivalent <br /> Title: Member/registered agent Town/City/County Clerk <br /> State of St) /O r(I CIO <br /> )ss. <br /> County of Q 5 ,r!I) I <br /> The foregoing instrument was acknowledged before me this /S f' day of r r cl.i'o2 h <br /> ()C. 9\14,by Brent A.Tamburelli as Member/registered agent of Tamrock Gravel LLC <br /> SUSAN arYPubERREZ Notary Public <br /> NoState of Colorado <br /> Notary ID#19984025762 <br /> My Commission Expires 09-16:2026 My Commission expires: 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 />