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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 requirements <br />of the following terms and conditions: <br />I . To the best of my knowledge, all significant, valuable and petmanent 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 34-32.5-1 IS(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-I15(4)(f), C.R.S.; <br />3. As the applicantloperator, I do not have any extraction/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado [.and Reclamation Act for the F,xtraction of Construction 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 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 [o section 34-31.5-111,C.RS., ajthe Colorado Land <br />Rec[amationActfortheExtraclionofConstructionMaterials. dn}alterotionormodifieatianafthisformshaUresultinvoidingany <br />permit issued on the altered or modified form and subject the operator fo cease and desist orders and civJ penahies jor operating <br />without a permit pursuant to section 34-31.5-713, CR.S <br />Signed and dated this __Z~'1 day of ~ U ~/ e' _, ~ o d _ <br />.~ <br />~ , If Corporation Attest (Seal) ~i .. _ <br />Signed~~.l~n~ <br />T . Vie. <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~ o~ Ot'e~~ ~ ) <br />) ss. <br />County of ~~~- j <br />The foregoing instrument was acknowledged before me this -~ ~ day of urv ~ , <br />ap~Z,by_~ar`o1c1 ~ _rlaw. _as ~re,Sld2n~ of ~14w~ eOv~S'kt~c'l,Inn =nom <br />V ~V`~~ 1Zt~E C~~~,/ <br />ti~o'~''~ _ Not Public <br />,V~ ;i;.°,, „.r"CJ~ My Commission expires: -) C)'a-Op <br />~~r ~p CC `t `~ ~. <br />SIGNATURES 1VfUST BE -N SLUE INK <br />N:a~dfshvrcwsfnrtm`S'urtvvumion i i2.dac (Approved OS/I V2005) <br />Title: P/' Cs .'.0 <n 7t' <br />