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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 I LI day of f-FvtyutS71 , c2aa y . <br /> Ln S tan C an�r� c� r I If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed: Si Signed: <br /> n Corpor Secretary quivalent <br /> Title: `re S,iltn Town/City/County Clerk <br /> State of C.o /o r•jo ) <br /> � )ss. <br /> County of / rt✓n o n�' ) <br /> The foregoing instrument was acknowledged before me this )y day of ffu ll <br /> o2bo?y,by 1 i'ke.- Langc-f» I <br /> n as Pres�r�c•.-� of 1angS�On 6eitrcr7t.. <br /> SNARON KAYE TURNER NotaryPublic <br /> I NOTARY PUBLIC-STATE OF COLORADO <br /> NOTARY ID I0174016484 <br /> MY COMMISSION EXPIRES APR 17,2025 0 ' ��On� <br /> My Commission expires: 4 (1 2 <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 />