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-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby ceRify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at [he 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.S-11S(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 applicanUoperator, I donot 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 Construcfion Materials <br />(Section 34-32.5-120, C.R,S.) as determined through a Boazd finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class I misdemeanor ptusuant to Section 18-8-503, C.R.S. <br />Thu jorm has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.RS., of the Colorado Land <br />Reclamation `fct jor the Extraction ofConsduction Materials. Aay alteratmn or modifrcahon ojthis form shall resuh in voiding any <br />permU issued an the aUered or modified jorm 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 />Signed and dated this ~~ day of CCtUSX.r d~ <br />•~~~~~i~~fiGh~~ ~~ <br />ApplicanUtQperator of Company me <br />Signed: J <br />Title: 6xec~t~ .e. DI v~c(v/ <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />State of Cn ~~ va.do } <br />ss. <br />County of~(~ahoC_ } <br />Town/CitylCounty Clerk <br />The foregoing instrument was aeknowtedged before me this °13~ day of OG~~'~ <br />__,by_Edward J- De L_n2Y</ _as E/x<cutwe Di 2cko/ of 6 • ~l-To <br />~~~~~~~ <br />NotaryNotary P~ <br />~ My Commission expires: Oq J.5 ap 11 <br />SIG~iATURES 17UST BEE LN BLUE INK <br />