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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 terns and conditions: <br /> 1. To the best of my knowledge,all significant,valuable and permanent man-made structure(s)inexistence 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 34-32.5-1 15(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 tindino. <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 firm has been approved bi•the Mined Land Reclamation Board pursuant to section 34-32.5-112,CR.S.,of the Colorado Land <br /> Reclamation Act for the F_:rtracdon of Construction Materials. Aty alteration or modification of this form shall result in voiding ant• <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 o26W� day of %J-Ll M..L <br /> ZAY" . 120VA Poh P64 Amil If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed: Signed: !V 0LJp <br /> Corporate Secretary or Equivalent <br /> Title: M h•e,,;- Town/City/County Clerk <br /> State of�I'tom Lv tMA=V ) <br /> (� )ss. <br /> County of -P�'Dl.t 41.5 ) <br /> The foregoing instrument was acknowledged before me this c2-1 ` day of ►�R <br /> oZ .by�►�6t►rr 1?o C►� '. Z-vi f' fA N;A as 1�Ltpylf�►-s of l <br /> JODI D SCHREIBER <br /> NOTARY PUBLIC N t Public <br /> STATE OF COLORADO <br /> NOTARY ID 20064001792 <br /> MY COMMISSION EXO REs OCTOSEFa 6,2026 1 My Commission expires:— U <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 />