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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 of <br />the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence aY the time this <br />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 law <br />(Section 34-32.5-115(4)(f), C.RS.; <br />3. As the applicant/operator, I do not have arty extraction/exploration operations in the State of Colorado euriently 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 Boazd finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statemerris made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />This form kas been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,CRS., of the Colorado Land <br />Reclamation Adjor tke Extradion of Construction Materials. Any aUeration or modification ojikis form skaU result in voiding any <br />permit issued on the aUered or modrfredjorm and subject the operator to cease and desist orders and civil perrahicsjor opaatargwvhout <br />apermitpursuant to section 332.5-123, CRS <br />Signed and dated this ~~ day of 1~C e,n be/~ aoo5 <br />AppGe t/Operato rCompa~Name <br />Sign <br />Title: ~Z~t3 <br />Stateof~rl-(~o~ra.t~o 1 <br />~/n ss. <br />County of _~„ ,F'X2J1 1 <br />,. _ <br />s <br />If Corporation Attest (Seal) <br />Signed: ~C~/11tr ~J ~~~tl..~ <br />CorporafeSecietary"orEgzeivalent <br />Town/City/County Clerk <br />The ferngoing ins t was aclmowledge <br />by n... ~ nhhi~ <br />SIGNATURES MUST BE IN BLUE INK <br />1V1:~in~+l,.rcbaG~uns~Cmswalon ~~za« tap~,roxa osirinoosl <br />My Commission expires: ~ .~~0 7 _ <br />