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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 mwmtun requirements of <br />the following terms and conditions: <br />1. To the best of my Imowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected area have bcen 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 34-32.5-1 IS(4)(f), C.R.S.; <br />3. As the applicanVoperator, I do not have atry extraction/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colomdo Land Reclamation Ac[ for the Extraction of Conswction 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 made <br />herein are punishable as a Class I misdemeanor pursuant [o Section 18-8-503, C.R.S. <br />This jo~m has been approved by the Mined Land Reclamation Board parsaant to section 34-32.5-111,C.RS., ojthe Colorado l and <br />Reclamaton Ad joi the F-xtradion ojConstracrion Materials. Any aheration or ntodifica6on ojthis jorm shall resuh in voiding any <br />permitissuedon the ahereda modifredjorm andsabjedthe operator to cease and desistorders andcivilpenabies joi operatrng »dhout <br />a pnrrrit pwsaant to section 34-32.5-]23, C.RS <br />Signed and dated this ~~~ day of <br />Jackson County <br />ApplicanVOperator or Comparry Name <br />Signed: ~'~°` 1., • l,t,c't•t.^~In <br />Title: Chairman of the Board <br /> <br />State of Colorad <br />ss. <br />County of Jackson <br />The foregoing instrument was aclmowledged before me this <br />by h:C~~r~n L. ('_ rowne-~~ as Cht;',r ~.n.. <br />If Corporation Attest <br />Signed: <br />Corporate <br />,' ~ r <br />/~~ ~"~ ~~ ~' ~ ~ L i~ <br />~~ <br />tt ~~> <br />~~ <br />day of ,~ <br />~of Jac~c,~cn. ~lxr n~lJ <br />oa"~ My Commission expires: ~1 - cal Q -U~ <br />xpires 098612009 <br />SIGNATURES MUST BE IN BLUE INK <br />,~, ~~,,,~,vr~,,,,,ca,~,v~,;~, ~ ~x a= (n~vvea osn trzoos> <br />