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-8- <br />Certificatlon: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and condirions: <br />i. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) inexistence 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-I 15(4xe), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 3432.5-i 1S(4xf), e.R.s.; <br />3. As the applicant/operator, I do not have any 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 in the application are 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.RS. <br />Thts jorm has been approved by the Mined Land Redamatton Board pursuant Io sec4Fon 34-11.5-III,C.RB, oj8re Colorado Land <br />Rtclarn~on Act Jor the Erdractfon ajConmucNon Materiah Any aherotloa or rnadljicaNon ojthts form shall rtsuh U voiding arty <br />permit issued on the ahered or nrodijltd jarrn and subject fhe operator to cease and desist orders and civll penabYea jar opoadng <br />wftlYout a persrit pursrant to sealon 14-325-121, GR.S <br />Signed and dated this 2l'"~ day of ~ bv'0nnt3EiL 200 6 ~' <br />~2.Op u-CCS t ~NC If Corporation Attest (cabal) <br />ApplicantlOperator or Company Name ;1. <br />Signed: Signed: ~i/~, <br />~., ^ - Corpora Secretary or Equivalent <br />Title: 't''1~t~T Town/City/County Clerk <br />State of <br />ss. <br />County of L~HA~,~~ 1 <br />The foregoing instrument was acknowledged before me this a 7 day of /~/~'M/~tT , <br />_, by ~G ~QLG ~I1/L'3FGC as _ PtQE'Sto tai.l'r of _ .~.4- P2ool<uS <br />SHARON K. CARR ~ CyQi}/2/ <br />NOTARY PUBLIC ~ Notaryi?ublic <br />STATE OF COLORADO // <br />My Commission Expires 6/16!2007 My Commission expires: ~~ ~L -~~ <br />SIGNATURES MUST BE IN BLUE INK <br />N~nenNbure~nfnmeCumnueiion ~Il.dac (Approved O3~11/2003) <br />