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-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has rr]et the mi]rimwn requirements oC <br />the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence a[ the time this <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-I IS(4)(e), C.ILSJ. <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 applicandoperator, I do not have arty 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 otperyury and that false statements made <br />herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This jorm hos been approved by the Mined Land Reclamation Board pursuant to secrian 34-32.5-112,CRS, ojthe Co%ado Land <br />Rechrmation Act jot the Extraction ojConstruction Materials. Any operation or modifuntion ojthis jwm shall resu8 in voiding any <br />permit issued on the ake~ed or modifredjorm and subject the operator m reuse and desist orders and civil penairiesjor opera6ngxVhout <br />a permit pursuant to section 34-32.5-123, C.RS <br />Signed and dated this 10TH day of MAP 2 0 0 6 .~~ _ ` .' <br />CARDER INC. <br />ApplicanUOperator or Comparry Name <br />Signed: <br />Title: <br />-: <br />_ ::-._ <br />If Corporation Attest (Seal) - ' <br />Signed: <br />Corporate Soc tar}• Equivalent <br />PRESIDENT <br />State of COLORADO ) <br />ss. <br />County of PROWERS I <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this 10TH day of MAY 2 0 0 6 <br />by RON PETERSON as PRESIDENT of CARDER INC.' <br />- <br />otarv Public <br />My Commission expires: J -~ l -~ q <br />SIGNATURES MUST BE IN BLUE INK <br />M:Lnjnlshae~wfamn~Cauwetion 112 doe (ApprovM 05/] 1/2005) <br />