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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)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 34-32.5-115(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. 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 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 permitpursuant to section 34-32.5-123, C.R.S. <br /> Signed and dated this 2U 01 day of WIC1'Y1�C,( G <br /> &4 614 u .l If Corporation Attest(Seal) <br /> Applicant/Operator,or Company Name <br /> I /^Signed: �L Signed: No Seal <br /> Corporate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> State of <br /> County of <br /> The foregoing ins��trum nt was acknowledged before me this day of I [l�U 1 I�l�i <br /> by- _T'L �1�/� �Yl as an a6 of 713 <br /> ZD74, I(�YL�S I�CICCI11 ,If/Z� <br /> ALYSSA CORINNE SCNAFER-C:310,2028 <br /> Notary blic <br /> NOTARY PUBLIC-STATE OF CDO <br /> NOTARY ID 202440040 <br /> MY COMMISSION EXPIRES JAN My Comnrission expires: Z <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 />