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8- <br />Certification: <br />As an authorized representative of the applicant, [ hereby certify that the operation described has met. the minimum 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 34-32.5-115(4)(e), C.RSJ. <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicanUoperator, I do not have arty 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 made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved 6y the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.RS., of the Colorado Land <br />Reclamation Ad jar dre Exbadion of Construcion Materials. Any alteration or modifuwtion of tirir jorm shall resuhw voiding any <br />permit issued on the altered or rreodifiedjorm and subjed the operator to cease and desist orders and civil penaltiesjo~ operatingxrlhout <br />a permit pursuant to sedion 34-32.5-123, C.RS. <br />Signed and dated this S ~` day of ~~mvU.2 a oo L <br />Thompson Properties p <br />ApplicanUOpemtor or Comparry Name <br />Signed: ~~/ <br />Title: Partner o <br />State of Colorado <br />County of Grand <br />ss. <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ day of c~e~.7ih16or- o L <br />by Larry Thompson ~ as Pa of Thompson Properties o, <br />T •~..4y <br />N, 1 <br />'".~`: e j o No ry Public <br />~'• My Commission expires: /~. -S •aoD9 <br />rt Expkes <br />5, 200e <br />SIGNATURES MUST BE IN BLUE INK <br />M:~~wm~~r~~con>vixu~, i iz as tMVrovea osn ~noos> <br />