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-8- <br />Certification: <br />As an authorized representative ofthe 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 lmowledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this application is filed, and located within Z00 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 law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I donor 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 F,xtraction of Construction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Boazd finding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-5-503, C.R.S. <br />This farm has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-712,C.RS., ojthe Colorado Land <br />Recamation Act jor the Extraction ojConstructu+n Materials. Any aheration or modiftcatlort of this farm shall resui7 in voiding any <br />permit issued on the ahered or modified form and subject the operator to cease and desist orders and civil penahles~or operating <br />without a permit pursuant to section 34-32.5-123, C.RS. '~"'~~~ ,"~"'~ <br />•. <br />r - , r ~b r+e, <br />Signed and dated this ~~ day of ~F-~-~ gF,IZ ~-II~LU~o ":~~'_ ='' '~ •t <br />:,; ~ ~ -- <br />~j ~ ~NFn,~ ANC If Corporation Attest 7Seal~r~ ~ ~' v <br />AoolicanUQverator or Com Name ?:~"~,'~i^ '?~!<•'~ <br />Signed: <br />Title: U t ~-~ P~ E sl <br />V~ <br />,¢S,S% Corporate Secretary or Equivalent <br />( t~{JYV 1 141' <br />State of ~O~D'fQ D ) <br />ss. <br />County of f`-C{l ) <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this -_ll`~~~__-..^ day of _~e~Q M ~Q _ <br />~, by _- _ as ~ ~~_ fN1~ L~~____G J-- of _~,[~~ <br />G Rr.. <br />~~~~31 <br />Notary Public <br />biy Commission expires: ~~1~~ 1 Q <br />SIGNATURES MUST BE IN BLUE INK <br />N9ndmslmremrfomn~Con%mrrion i 11.aae (Approved OS{~ I:2U05) <br />