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-~- <br />Certificstioo: <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 />l . To the host of my knowledge, all significant, valuable and permanentman-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.RS.). <br />2. No mining operation will . be located on lands where such operations are prohibited by !aw <br />(Section 34-32.5-1 i5(4xf), C.RS.; <br />3. As the applicantloperator, I do not have any extraetion/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Ad for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Board fording. <br />4. T understand that statements in the application are befog made under penalty of perjury and that false statements <br />made herein ate punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />i7tis form has been approved by the Mined Land Reclantotlon Board pursuam to suction 34-32.5-112,GRS, of the Cotorado Land <br />ReclwnaA'on Adjor the Fa4aclion ojConstradlon MetertaLt Any alteration ormod fuatlon ojthisform sha!lresult in voiding any <br />permit issaed on the altered or modified forrJt oird subject the operator to cease and desist orders and rtivi/ penalties jor operating <br />witlmru a pcrndt parsaant to sicction 3f3~123; GRS { <br />Signed and dated this _~~ day of ~i0-4-_ . ~~ <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: C1W ~ 02.^ <br />Town/City/County Cierk <br />State of <br />ss. <br />Countyof~ b ~' ., <br />The foregoi rostrum t was acknowledged before me this ~_ day of </+~~"1' aO0 y <br />by ~. ~ muoa o 0 3k LLB - <br />y~~y L / <br />:r1 ,+Y <br />~oTaer ~: by <br />-o_o-.o- ; <br />'OUBL~~ ' ~ Notary Public <br />~~ . °t~!' .......•~j8 <br />~~~. <br />xuhtxu~ My Commission expires: 3 ~ - D~ <br />SIGNATURES MIDST i<N H4UE INK <br />A1:w®tiW.eWdwm,~Cuemroenm 1e2mc (o7nvaea) <br />