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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 minimrmr requirenaus of <br />the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-maw structure(s) in existence at the time this <br />application is filed, and locate! within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-1lS(4xe), C.RS.). <br />2. No mining operation will be locate! on lands where such operations are prohibited by law <br />(Section 34-32.S-11S(4xf), C.RS.; <br />3. As the applicanUoperator, I do not have arty extraction/exploradon operations m the Stale of Colorado curently 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.RS.) as determined through a Board finding. <br />4. I understand that statements in the application are being madc under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />llrir jornr her beery approved by lire Moved Land Rec/amalion Board paraaaM to aeaion 3J-32.5-112,C.RS, ojrhe Colorado Lmrd <br />Rtdamafion Ad joy abe ExbaAion ojConsbrr~on Maleria4 Any aheraoion or nrodific~ion ojdria jwm ahatl reaaEt in voidng any <br />pennll isaned onlbe obeyed a arodifredjornr andsabjeerdre operator to cease and dat4ordera oadrnil penabfes joroprra/brgx~hort <br />a ptrnrit pwsaanl to sedioe 34-32.5-123, CRS <br />Signed and dated this ~_ day of ~~ v- n >Z `~~ <br />C ~~~r2~ <br />ApplicanUQperator a Comparty Name <br />Signed: <br />Title: <br />If corporation Attest (Seaq <br />Signed: - ~~~~/~'~- <br />~'~ Cotporat Secretary or Equivalent <br />State of lN1GIQdl) 1 <br />` ss. <br />Countyof~l~~'X~ 1 <br />Town/City/County Clerk <br />The foregoing instnmremt was acknowledged before me this _~_ day of ~. /.tlJ~ <br />by ~ Ctf 1 .~YVIt-~I as~Gl"f (Y,IT fP~ 1) of Y <br />~~.~,•U..''•.~ , <br />G~ <br />Tsn•OD o ~- ~~r e <br /><~ :•r3,• <br />'•. <br />6u- ~' ' ~"-vim I <br />Notary Public <br />My Commission expires: ~-q - ~~ l <br />•"• Qq:j~••••"•:'~~.` SIGNATURES MUST BE IN BLUE INK <br />C M:~w~.e~.,r~ncwo,..v~i~xa«(nppureaosit~noosl <br />