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- 8 - <br /> • <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 stnicture(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(44)(e), C.R.S.). <br /> 2. No mining operation will be located on lands where such operations are prohibited by la\\ <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 th is 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 /> //D M101-RC-I-k- <br /> Signed and dated this C day of , 4a0.9.V . <br /> If Corporation Attest(Seal) <br /> App icant/Operator or Compa Name ND &mit <br /> L.7)Signed:g (,?LY <br /> Si '/1'� Signed: <br /> Corporate Secretary or Equivalent <br /> Title: 00AMC- Town/City/County Clerk <br /> State of LU i, d.(XO,_ o ) <br /> ) ss. <br /> County of IJ(\L.) lyyk ) <br /> The foregoing instrument was acknowledged before me this (5, day of MATE Ux E , <br /> 02 ,by 1CiS6 n G(�QA062A' C(iU as NAGlf1 it CV� of C)(1Q/tY y tca.4 eh), . <br /> AMBER PRATHER / <br /> NOTARY PUBLIC <br /> STATE OF COLORADO Not Public <br /> NOTARY ID 20064032817 <br /> MY COMMISSION EXPIRES AUGUST 18,2026 My Commission expires: gf.( $i Zd?co <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 />