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-x- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimtmt regtrirattads of <br />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 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-I15(4)(e), C.RS.). <br />2. No mining operation wilt be located on lards where such operations are prohibited by law <br />(Section 34-32.5-115(4)(£), C.RS.; <br />3. As the applicant/operator, I do not have artyextraction/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.RS J as determined through a Board finding. <br />4. I understand that statements in the application are being made underpenalty ofperjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Suction 18-8-503, C.RS. <br />77rtr jornr hm been approved by the Mbred Land Rer/anradon Board pwsrant ro section 3~3S.S-112,GR orado Land <br />Redanratlol. Ad jor tke Extracdox ojConmudlox MarerTala Any al<aation or n+odlfication ojthitja shall rawEt Lr vo any <br />pernrIIiuuedourNreaG4redornrodjJiedjorinandsnbjedlheopadorAvcrareonddesldorderrand paraEtiajoropes~rrgx' <br />apermirparraaMtosecdon34-31.5-723,GRS - % ~'~`~,~du~ <br />Signed and dated this ~~ day of <br />Appli t/Operator a Comparry Name <br />Signed: <br />Title: ~i~ e i ~ d p~ <br />State of ~ am `O N~ coo . 1 <br />County of ~-P Sa 1 ~ <br />The <br />UN''p..~~~,,1..E <br />IZINV~'~ <br />b ~ .ir G`~' J <br />Attest lSe~al)~~ ~ L <br />Town/City/County Clerk <br />this 3 ~~day of <br />My Commission expire (P <br />SIGNATURES MUST BE IN BLUE INK <br />e.:~~e.etir'~.~c~.,~ uza~ ta~o..a os/r tnoosl <br />