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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 .4 day of V£G�GW1'Y , 7.»0-z-`-k• <br /> "Vesk•ft S+e mete -. Kec-trAnn Slime vAAAenatts <br /> 4 If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed: 1 Z\ ��- Signed: <br /> Corporate Secretary or Equivalent <br /> Title: Pitt►1e61 e CY 1c A Town/City/County Clerk <br /> State of Co I o'v-0).n ) <br /> )ss. <br /> County of Gc..rtpp-►�!A ) J <br /> The foregoing instrument was acknowledged before me this 3 •r� day of I�cce•�� .r' <br /> ,by 1-er..►vi3 S'tV-.4.-Ja-'"r as Fre.siotu .1- o pP.tro.-ho..►Sof t"ios 'n' 51oec M"-r-ra1-s <br /> TIMOTHY OLK <br /> NOTARY PUBLIC Notary Public <br /> STATE OF COLORADO <br /> NOTARY ID 20164038408 1/2 7�o Let <br /> COMMISSION EXPIRES JANUARY 27,2029 My Commission expires: <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 /> I <br />