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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 13•6 day of 3,,14e , 202i f . <br /> S �J f"S t ' �+ >.vtc_. If Corporation Attest . . • EC�r� <br /> ��e _�� ��s Ca• <br /> Applicnt/Operat6r or Company Name �1 <br /> C . <br /> Signe <1_ - ` " ` — Signed:11, ' Z <br /> Corpora et• �.'�� vat- • <br /> Title: President , +c <br /> LORA` <br /> State of L, l,;.L ,,X ) <br /> _ )ss. <br /> County of j),>.4, 1,•c_v‹. ) <br /> •The foregoing instrument was acknowledged before me this i,38day of .!—Pk eL , <br /> ,,20 24,by I-) .Z,I.4.:2, , 1/t/. :t 6, as 1-7,L`-,.--.1--,..-.,i_ of -43,41.4 C�.5/,...._. :-J-f-.1:,)- c_01.-1-70.,:_. <br /> Jan Nelson / ,i'NOTARY PUBLIC Notary Public <br /> STATE OF COLORADO <br /> NOTARY ID 19994030527 <br /> MY COMMISSION EXPIRES May 03,2028 My Commission expires: "i i -✓,i=. ,2c <br />