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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 /> I. 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. 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 permit pursuant to section 34-32.5-123,C.R.S. <br /> i4A <br /> Signed and dated this nl day of 1 Aac , <br /> �-(c11 \( If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> 1 <br /> Signed: /g ., Signed: OA 1; .Oi i I 4 (1 Irian <br /> Corporate Secretary or Equivalent <br /> Title: _() 1�1� tu/1 C,‘tit k.K Town/City/County Clerk <br /> State of t'VAILA <br /> (,�( ) <br /> ss. <br /> County of )(1qj,��t ) <br /> JJ Y` <br /> The foregoiN instrument was acknowledged before me this �,, , day of �, Q(Xa9 <br /> �� by t Q1nc�, ,rc as eD iuk�S►t r of Oa&iL1t'1 <br /> CHRISTY M PUBLIC N 44 iliettoelio <br /> NOTARY BECKM <br /> STATE OF COLORADO Notary Public <br /> NOTARY ID 20114029279 <br /> MY COMMISSION EXPIRES MAY 17,2027 � ��'��� <br /> My Commission expires: a� <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 />