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-7- <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements of the <br /> following terms and conditions: <br /> 1. All necessary approvals from local government have been applied for(Section 34-32.5-110(1)(a)(VIII). <br /> 2. To the best of my knowledge,all significant,valuable and permanent man-made structure(s)in existence at the time this <br /> 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.). (NOTE: For 110 operations,the affected area includes all lands delineated by the permit <br /> boundary.) <br /> 3. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32.5-115(4)(f), <br /> C.R.S.). <br /> 4. As the applicant/operator,I do not have any mining/exploration operations in the State of Colorado currently in violation of <br /> the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials(Section 34-32.5-120,C.R.S.). <br /> 5. 1 understand that statements in the application are being made under penalty of perjury and that false statements made herein <br /> are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S. 1984. <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-110,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 1 711 day of A f /( , 2_02_- . <br /> /I/ Ia , b <br /> N) e_ t/'"i L C If Corporation Attest(Seal) <br /> Applicant/Operator <br /> Signed: --7711 Signed: <br /> Corporate Secretary or Equivalent <br /> Title: JW(g-e- ,A-r N- jrCe< Town/City/County Clerk <br /> State of CO/0 rct cLm ) <br /> )ss. <br /> County of prrt,c inp i ) <br /> The foregoing instrument was acknowledged before me this 15th day of Apr:I 2025( , <br /> ,by fostek HAr, }'°r) as Qytp'clot of OP Kc (NaY IL_ . <br /> � <br /> � <br /> ANDREW N CARROZZANot./ 'ublic <br /> NOTARY PUBLIC <br /> STATE OF COLORADO My Commission expires: 14(36/202-4— <br /> NOTARY ID 20234041054 <br /> MY COMMISSION EXPIRES 10/30/2027 <br /> SIGNATURES MUST BE IN BLUE INK <br />