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8- <br />Certifcatioo: <br />As an authorized representative of the applicant, T hereby certify that the operation desaibcdhas and the minimum requaernaas of <br />the following terms and cerditions: <br />t. To the best oCmy knowiedge, all significant, valuable arxl permanem man-made swcture(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 />(Beefier 34-32.5-I15(4xe), C.RS.). <br />2. No mining operation will bt located on lands where such operations are prohibited by law <br />(Sechon 34-32.5-I15(4)(f), C.RS.; <br />3. As the applicantloperator, I do trot 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 througfi a Board finding. <br />4, I understand that staternents 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 t8.8-503, C.R.S. <br />TRis josm has been approved 6y the Mined Lmrd Redanration Beard pursuant W aea[ion 34-31.5111,G/ZS, ojthe Colorado Load <br />Reclamation Ad joi the F.xtradion oJConsbudbn Maferiob. Any alteration a modification ajtlrirjorm ahaU teens br voidag any <br />permit iaaaedon the aRoed a modifiedjorm and aabjectthe operator m cease anddeatrtorden and drLpeaahYerjor op~Lg»ldioa[ <br />a permit pwaaaMfa aedion 34-32.5.113, CR.S <br />Signed and dated this ~ day of ~ /JC7 6 <br />l ~o na ~ ~A,n f ' S o /// If Corptxation Attest (Seal) <br />ApplicanUOperator err Company Name <br />Sigrred: ~p p,It.Y PVe~ Signed: <br />Z` ~ ~.,.. V .. •. ;~C' Corporate Secretary or Equivalent <br />t ; <br />Title: = C~Irti€RS ~ Town/City/County Clerk <br />State of ~~ ~t<FCO~ <br />ss. ,~ <br />County of \ 1, ~ (Af1k415:'~=1 ^.`,~IfCS_tJ -17 .{~ ~ /~~~~ ,~ <br />foregoing instrtrrneat was aclvwwledged before me this ~ day of , f S~`4' <br />~~~'~ ~ tllrr.'~-~h(l as~~ t~no,t ~(1L1a_f~ \( ~f e (' (L . , ~- <br />~~.~~~ <br />Notary Public <br />My Comroissiet expires ~ ' ~ ~ •~~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:~otinWvo~v.Wum`.Cwevmtim 113 dog (Approved 05/1IfI0a3) <br />P~. <br />