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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 lime <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-I I5(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicandoperator, I do not have any extractioNexploration 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 arc punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Thu jorm has been approved by the Mined Land Reclamation Board pursuant to section 34-3Z.5-171,C.RS., ojthe Colorado Land <br />Reclamation Act jot the Extraction of Construction Materials. Any alleration or modiJleation of this jorm she/! result in voiding any <br />permit issued on [he altered or modified jorm and snbjeM the operator to cease and desist orders and civil penaldes for operafing <br />without a permit pursuant to section 34-32.5-113, C.RS. <br />Signed and dated this ~ day of QPce,~nl7P1` a7no6 <br />dl~lcaslleSUC~e zee. tl6n /fn,~{_ e~/nMtY.vt~s <br />ApplicantlOperator or Company Name <br />Signed: <br />OfHFfo r!P~ay If Corporation Attest (Seal) <br />Signed; <br />Corporate Secretary or uivalent <br />Title: ~'cC P/PSt/~Pn'7~ <br />1'owro'City/County Clerk <br />State of C o r a~ o ) <br />ss. <br />Countyof_~e',S a _} <br />The foregoing instrument was acknowledged before me this ___,5_Itl-~. day of _._~c.ew~'I v1r, r,' <br />.io,2ta..by [,,-L(t.~~.4s.~~11~r~T_-_asf~;ci,PfeS~~a.M~ of_~jc~,casf~.e SW ro'.•.•.• ...••.•. <br />' ~,,.,....~ J /f / ~/ ,~ // <br />~' >1'.,A~B19 __G~1l~G-ai2a- GI - ~!J„LGCv~i~'~_~:~:~:1:~:~:~: <br />;~ -~ :'~ •tf y ~ Notary Public <br />o ; ~ ~ y' ' p'fi•: <br />" i i7~ A "I : ~` <br />c ~ +'~ bfy Commission expires: _~~ c?~3 c7p~, <br />.:v: i ¢~ a <br />•=.,,~1p~•••••y;~•p'x SIGNATLiRES MIDST BE IN BLUE INK <br />Ni?rtiinv~naiFMfp~s~i~m4"m~ipdii2.doc (A~rm~ed 0511112f~5) <br />