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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />L To the best of my knowledge, ail significant, valuable and permanent 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 34-32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations aze prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicanboperator, I do not have any extmction/exploration opemtions in the State of Colorado currently 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.R.S.) as determined through a Board finding. <br />4. I understand Utat statements in fire application aze 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 />77+is jornr has been approved b7' the Mined Land Reclamation Board pursuant to section 34-32.5-]I2,C.RS, ojthe Colorado Land <br />Reclamation Act for the ExtracSon of Construction Materials Any operation or modification ofthis josm shaUresuU in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuaru to section 34-32-723, C.R.S <br />Signed and dated this I~ O~ day of ~}4r; ~R1~IlG f 7~t <br />+ <br />\QFIn'Y.fli 4C~(A6 ~ UC\, 1~aC, IIJC <br />AnolicanUOoerator or Comoanv Name <br />Signed: <br />Title: <br />State of l(C~C+t_+'+~`~ ) <br />(~ \ ) ss. <br />County of \ ~ ~ YY1Gttt ) <br />The foregoing instrument was acknowledged be <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />this ~ ~nkh day of <br />My con' <br />Commission expires <br />Town/City{County Clerk <br />1~:v, lq, C~~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:+mivuLVe~vsfo,ms+Canmuctiao i~z.a« (or2srzaoa> <br />