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-8- <br />Certification: <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 conditions: <br />1. To the best of my knowledge, all 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 azea 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 are prohibited by law <br />{Section 34-32.5-1 IS(4)(f), C.R.S.; <br />3. As the applicanUoperator, 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 aze 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 34-31.5-111,C.RS., ojthe Colorado Land <br />Reclamation Act jor the Extraction ojCoxstruction Materials Any alteration or modification ojthis jorm shall result in voiding any <br />permit issued on the altered or modified jorm and subject the operator to cease and desist orders and civil penalties jor operating <br />without a permit pursuant to seMion 34-31.5-113, C.RS. <br />~~ <br />Signed and dated this ~_ day of ~ /~" y 2nA~ ~ <br />,.1~17'I .~T/:'/L=C=~Lc/ JTG/~.~ W'I~D~~~~C~i ~~~~~• If Corporation Attest (Seal} <br />ApplicanUOperator or Company Name <br />~~ ,i: S i 6J,~i./ r <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~-- J ~ 0 ~'4 r~ ~ ) <br />/ ) ss. <br />County of t- ti r. i~ ~ ) <br />The foregoing instrument was acknowledged before me this ~ day of '~ ~ ~ <br />>UC~~,bY~n Str ~ as ~~~5;~40.~-}- of Spa ~h~lrs~ ~ c <br />_ o®~ V n~ <br />O~(P;: r•~••~. ~!B~ Notary Public <br />=rr ••.~C~ / / <br />~ ~ SHANE 's My Commission expires: ~~ / -~l ~ ~ <br />ASKIN <br />.1 SIGNATURES MUST BE IN BLUE INK <br />~sNm ~•• (Approved OS/II/2005) <br />AM Commheion Emires Oe1 D. 70D6 <br />