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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 minimtan regidranems of <br />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 this <br />application is filed, and located within 200 feet of the proposed affected area have been idattified in this application <br />(Section 34-32.5-1 I5(4)(e), C.RSJ. <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.RS.; <br />3. As the applicant/operator, I do not have airy extractioo%xploration 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.RS J as determined though a Board finding, <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class t misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This jorm has been approved by the Mixed Land Reclam~iax Board pursuant to secSon 34-32.3-I12,CRS, ojthe Colorado Land <br />Redanra6on Ad jar Ike Extradion ojConstrurrian Mmerialx Any alteration or modifuation ojtlris jorm shall resa@ ix raiding any <br />pamit issued on the ahered or rnodifurdjorm andsubjed the operalorto cease and desis[orden and avilpenaldes jar operatingr~liad <br />a permit pursuant to seadon 3J-32.3-123, CR.S. <br />Signed and dated this ~ day of C~~~~rni~~- , a°f~~ - - - - - - <br />~~ _ - <br />~~~-~ ~%aJoa ~YG If Corporation Attest (Sear ", - - <br />Applic5nl/OperalorarCompprryName = ~' -~~~ <br />~'- - <br />.~.-.> ~ ~! i~?_ ~ ., ~ I% ems--- - <br />- ' ' ~` `~ Cor~rate Secret'ar`y or Equivalent <br />-. z~. / <br />Title: <br />Stateof~l8/"Q~'~ ) <br />// ) ss. <br />County of/~/i/92~ 1 <br />The foregoing rostrum®t was acknowledged bef me this, A~ day of _ <br />by ~//z~!~ ~i.~~ ~i~P S ini'.o rr <br />~o NUSS6 <br />.• <br />;~ 1yOTAR <br />- .~.~. <br />Town/City/County Clerk <br />Conwission <br />MUST BE IN BLUE INK <br />-~' <br />My Commission <br />Expires 2-14-2006 <br />