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-8- <br />Certification: <br />As an authorirxd representative of the applicant, I hereby certify that the operation described has met the mhritnum regturentents of <br />the following terrrts and conditions: <br />l . To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located Within 200 feet of the proposed affected area have been identified in ails application <br />(Section 34-32.5-1 l5(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-1 l5(4)(f), C.R.S.; <br />3. As the applicanUoperator, I do no[ have any extraction/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act Cor the Extraction of Construction Materials <br />(Section 3432.5-120, C.RS.) as determined through a Board finding. <br />4. 1 understand that statements in the application are being made under penalty of perjury and thaz false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Sxtion 18-8-503, C.R.S. <br />Thin jnrm has been approved by tlee Mined Lend Reclamation Board pursuant to section 34-31.5-111,C.RS, oJthe Colorado Land <br />Reclamation Ad jot tlu £ztiracrion of Constrvdian Materiaix Any aCeration or madifaration oJffiia jantr shall resa8 in voiding tiny <br />pa,nirinaedon the oCered ar modijkdjorm and sabjecsthe operator to eeareand daistorders andnvil penadtresjor aprradag»mliord <br />a pe~writ prrauaM to section 3J-31.5-113, C.RS <br />Signed and dated this ,n, I ( °II ~ day ot~ ~. <br />D~ tf n (IIVY7 '~- ~ i ~1'LG , If Corporation Attcst (Step <br />ApplicamlOperator or Comparry Name I' ~ _ I <br />Signed: ~ Signed: ~~ `~ "~'~-~ <br />Corporate Secretary a Equivalent _ . <br />Title: ~t Lr ~~es Tovvn/City/Cowry Cieik_'~`_~ ~• ~ ~ <br />State of l AiY L~l ~AV ) y .~ <°_' , ' •°_ r.;_:'~- c <br />County of ~~~ ~ II ~ ~~ t ~ ~ /!r ~ -,~~.:= r^ <br />The foregoin instrument was acknowledged before me this ~~ day of ^^ II ,, ,,,,'' ,,,, ~~ ,(" q~~ ~. <br />by as l) f CA , D/JI '~' of ~-~,t~XIY/\ ~ YUn~~ M Q rl v"`- <br />~~ Q . ~-(.(~ o ~ ,mot <br />Notarv Public h <br />My Commission expires: ~ ~ ~ h <br />MUST BE IN BLUE INK <br />