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-8- <br />Certification: <br />As an authorized represemative of the applicant, I hereby certify that the opaation describodhas act thenunuwm req(riremeNS of <br />the following temps and corrdiaons: <br />1. To the best of my knowledge, all signi6cam, valuable and pernuaem man-made structure(s) w 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 34-32.5-1 l5(4xe), C.RS.). <br />2. No mining opcation will be located on lands where such operation are prohibited by law <br />(Section 34-32.5-115(4xfj, C.RS.; <br />3. As the applicanUoperator, l do nd have airy extractionlexploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Constnrdion Materials <br />(Section 34-32.5-120, C.RS.) as determitcd though a Board fmding, <br />4. I understand that stataneats in the application are being made uraier penslry ofperjury and that false staterttents made <br />herein are punishable as a Class t misdemeanor pursuant to Sectim 18-8-503, C.RS. <br />T7rir janw bas brew approved by de Maned Lend Rerforrradaw Board prrawaM w sera'nw 34.343-I12>GKS, of rke Cobrado Land <br />Rrdamariow Aajw rAae Fxbcdkw ajCautrrctiow Mafoials Awy altrratiow or rwo~JrnGow ajrkajana sMaU reraU iw 1 awy <br />permit irauedoa Me adtwed or madiJrdlfmw~ aadwbjeddle operabr m contend deei,ziwdns and rivilpnradtiesjorapval3~gwie4ort <br />a perndt prnwaR m .ucrtoa 3I-3a.3-113, c.lts. <br />signed and dated dua~P ~ day of SC~TF_VYt BEI~ <br />/~ (S' ~. C~ 2/k v If Corporation Attest (Seal) <br />Applicaml0paator or Comparry Name <br />Signed: Signed: <br />/~ (. `/~ //- P Corporate Secretary or Equivalent <br />Title: / l r' V r " ~ ^ Town/City/County Clerk <br />Stan of <br />ss. <br />County of ~lf~ 1 <br />The foregoing.inswau;ntwes acknowledged before me this _ /~ day of ~k~}z'/Z _ <br />by as ~7CONE,e 9f ~rd> - C?Ac,A, <br />0 <br />My Commission expires: I ~ OO <br />,:IUtnOUrr>,.: <br />SIGNATURES MUST BE 1N <br />M:`aveWive\wl'mm'Cmdntlim 1133e (A~wa005/11?Da5) 41`-~n ~y,.••..---"i. ~9 <br />6` s~ • "~• ~ ~~r <br />~~~/ cL~V •,~i <br />°.~ ~~ ~` a~ to -M <br />1 <br />