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- 8 - <br /> Certification: <br /> As an authorized representative of the applicant, 1 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, know ledge.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-I 15(4)(e).C.R.S.). <br /> 2. No mining operation gill be located on lands where such operations are prohibited by law <br /> (Section 34-32.5-1 15(4)(i), C.R.S.; <br /> 3. As the applicant'operator, I do not have any extraction'exploration operations in the State ofColorado 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 I misdemeanor pursuant to Section 18-8-503. C.R.S. <br /> This farm has been approved hr the Mined Land Reclamation Board pursuant to section 34-32.5-112,CR.&,of the Colorado Lund <br /> Reclamation.-1 c ifor the Extraction c f Construction Materials. .-t n; alteration or modification of this firm 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 far operating <br /> without a permit pursuant to section 34-32.5-123. C R.S. <br /> Signed and dated this JO' day of 1 / a.A4 . c20 a4 . <br /> 44t1'Lk ASet i If Corporation Attest(Seal) <br /> Applicant:Operator or Company Name <br /> / <br /> Signed: AiA /4. _� ' Signed: <br /> Corporate Secretary or Equivalent <br /> Title: ____ y Pa i s '&4 41J €WV44(t LU. t own City/County Clerk <br /> State of Nis v _L1,,o ) <br /> -PI <br /> } ) <br /> County of �f I,,C] <br /> The foregPkL <br /> instrument was acknow ledged helore me this et" day of /1/401 <br /> ,,''�" ,(� t <br /> oleo*, by 4 �� as 11�L11NLL of "AL/et <br /> U.i <br /> Public <br /> My Commission expires: `01(1/ea, <br /> SIGNATURES MUST BE IN BLUE INK JODi D SCHREIBER <br /> (VOTARY PUBLIC <br /> STATE OFCOLORADO , <br /> You must post sufficient Notices at the location of the proposed mine site to clearly ide tify tliloAp eigdos 1e $a <br /> MY COMMISC:0N EXPIRES OCTOBER 6,2026 <br />