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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 time <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 15(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-i 15(4~f), 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 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 are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Tbis farm has been approved by the Mined Lond Reclamation Board pursuant to section 34-32.SJ71,C.RS., ojthe Colorado Land <br />Reclamation Act jor the F,xtrac[fon oJCons4uction Materials. Any aperation or modification oJthis jorm shall result in voiding any <br />permit issued on the ahered or modified jorm and subject the operator to cease and Jeslst orders and civR penalties jor operating <br />without a permit pursuant to section 34-31.5-113, C.RS G / <br />Signed and dated this ~ day of ~ ~~~r- 200 <br />If Corporation Attest (Seal) <br />ApplicanUOperator or Company N~ <br />Signed: <br />Title: /~'lanagBC` <br />Stateof~Is',4'7b ) <br />ss. <br />County of ~ ~fJ-SO ) <br />Corporate Secretary or Equivalent <br />Town/Ci[y/County Clerk <br />T'he foregoing in trument was acknowledged before me this ~~ day of_ rV~~ <br />~~~~yyyy~~~~~ c_ ~----' <br />CY~^s", by -----~-- ~~_ as ~t7(.~ f~ ~ ~ ~~Q~~DY of-- <br />Signed: <br />~ n <br />Notary Public //nn~Q <br />My Commission expires: __~'~VSLSl. <br />SIGIVATL7RE5 MUST BE IN BLliE IhK <br />Sifmnm~tlwremxfiimn'Cortemelion I ^.da fAppnrved 05111%2fN15) <br />