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-8- <br />ertification• <br />As an authorized representative ofthe applicant, I hereby certifythat the operation described has met the minimum requirements <br />of the following terms and conditions: <br />I. To the best of my knowtedge, all significant, valuable and permanent man-made structure(s) inexistence at the time <br />this application is f led, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-1 IS(4)(e), C.R.S.). <br />2. No mining operation will be located on lauds where such operations are prohibited by law <br />(Section 34-32.5-I15(4)(f}, C.R.S.; <br />3. As the applicantloperator, I do not have any extraction/exploration operarions 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 Boazd finding. <br />4. I understand that statements in the 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 />This farm has been approved by the Mined Land Reclamation Board pursuant to section 34-31.5-112,C.RS., ojrhe Colorado Land <br />Reclamation Act for the F,xtraction ojConstractwn Materials Any alteration or modifreation of this form shall result 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 pursuant to section 34-32.5-123, C.RS. <br />~igned and dated [his Z~-~ day of= 1/I~',~~- , _ ~6 ~ <br />Applicant/Operat r or Compan ame <br />If Corporation Attest (Seal) <br />Signed: `M ~i <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: ~0inyuc,,1 Wlol,-.G G~~ <br />1'own/City/County Clerk <br />State of (',oLORADO ) <br />ss. <br />County of ~~ 41'1 5 ) <br />The foregoing instrument was acknowledged before me [his o~ 7~ day of U S7~ , <br />Z~o~by T OYYIAS {~A-U I _ as L~ENEQgL_(~kA/hGFiZ off~toArr ~It-N[~E C-,C-„2tGl}rP~ <br />LCG <br />~P~GIA,L.geB ~¢~~~ ~ (~e.v <br />QP.~OT'4A~•.F~, Notary Public <br />My Commission expires: ~ v 3O~D Z_ <br />N.` .A v .•0 <br />9~, •., ~/Q ~ i ~ QO <br />F OF~~'- RES MUST BE IN BLUE INK <br />M:U~unsAare\yfgma`Consimciion 112.dce (Approve <br />MYCamiissionE~ires ta3t1r100) <br />