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-g- <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 Imowlodge, all significant, valuable and permanent man-made structure(s) le existence at 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 34-32.5-1 l5(4)(e), C.R.SJ. <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 applicanUoperator, I do not have arty extraction/exploration operations 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 that statements m the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section IS-8-503, C.R.S. <br />Thk jorm has been approved by the Mined Lond Reclamatan Bond pursuant to section 34-32.5-I ]2,GR&, ojthe Colorado Land <br />Redamation Ad jor the F-x4adion oJConstrucrion MateriaLx Any akeratbn or modifuwtion ojthrs jorm shall resole in voiding any <br />pomkiwued ontlie akered or modifiedjarm and sabjedthe operator toceare and desistorders andcivrlperrahiee jor opa~ng »d/Fout <br />a permit pursuant to section 34-32.5-123, C.RS <br />Signed and dated this 11th day of <br />• Pelino, Inc. <br />Applicant/Opera Comp <br />Signed• <br />Title: <br />President <br />State of Colorado 1 <br />ss. <br />County of Chaffee __~ <br />The foregoing instrument was aclmowledged before me this 11 to <br />by Scott Pelino as President <br />,P`~'pTgq <br />2006 <br />day of July 2006 <br />_of Pelino, Inc. <br />Notary Pubti <br />My Commission expires: ~O /9- D~f <br />SIGNATURES MUST BE IN BLUE INK <br />MMinbhueT3 doe (Approved 05/11/]005) <br />• <br />