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-8- <br />CertiLcation: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the nrirlirrnart requirements 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 34-32.5-1 IS(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by ]aw <br />(Section 34-32.5-115(4)0, 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 Boazd finding. <br />4. I understand that statements th the application are being made under penalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.RS., ojthe Colorado Land <br />Reclamation Act jor the Extraction ojConstruction Materials. Any alteration or modification ojthis form shall result in voiding any <br />pe~miJ issued on the aUered or modified joim and subject the operator to cease and desist orders and civil penalties jor operatingwi0kout <br />o permit pursuant to section 34-32.5-123, GRS. <br />Signed and dated this ~_ day of ~j(,~,Gfn ~]/ X005 .. <br />;:'J;. ;:- - ~~- <br />i t::'. {t <br />SCHMIDT CONSTRUCTION COMPANY If Corporation Attest l(~e~)Y ~,ti ` v `, ~, <br />ApplicandOperator or Company Name r . ~, ~ ; ': <br />-. In. • v~y .~ r,',~ <br />~ .•• <br />,.-. <br />Signed: Signed: ~ ~ ~'~' <br />Corporate Secretary or quivalent <br />Title: r'~ a,(~__~/1p,l~a~ ~ Town/City/County Clerk <br />State of I.O~OI'GfdO ) <br />ss. <br />County of E ~ PGiSU I <br />b e fo ins ent was acknowledged before me s _~~ day of <br />y ~ as (/~s t ~ag,S x ~ . ~ of <br />o : '~'`` Y <br />Public •, p~~~~C, <br />My Commisslon <br /> <br />SIGNATURES MUST BE IN BLUE INK <br />M:Imin~share\vef'amu\Comwaion 112.doc (Approved OS/11/1005) <br />