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-7- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that [he operation described has met the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and pemianentman-made stnrcture(s) in existence at the time <br />this application is filed, aml located within 200 feet of the proposed affected area have been identified in this apphcation <br />(Section 34-32.5-115(4)(e), C.R.S J. <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(!), C.R.S.; <br />3. As the applicanUoperator, I do not 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 Constuction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Board Finding. <br />4. T 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 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved by the Mined Land Reelamm~iion i3om~d pursuant to section 34-32.5-IIl,C.RS., of the Colorado Land <br />Reclamation Ad for the Edradion of Construction Materials. Any alteration or modifuation of this form shall result in voiding any <br />permit issued on the ahered or modified jorm and subject the operator to cease and desist orders and civil penalties jor operating <br />without a permit pursuant to secrion 34-32-123, C.RS. <br />Signed and dated this 2 day of Febuary 2 .2005 <br />Van Valkenburg Cattle Company,LLC <br />If Colpomtion Attest (Seal) <br />ApplicanUOperator or Comparry Name <br />Signed: ~ O <br />Title: Owner <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of COLORADO ) <br />ss. <br />County of JACKSON <br />The foregoing ins ~ s acknowledged before me this day of Febuary 2 , 2005 <br />_, by Wi '~' as Owner of Van Valkenburg Cattle CO..LLC <br />' ~, <br />Notary Pub c <br />N'~9pA~Bl.~G' pOO <br />~, .•OQ' My Commission expires: <br />OF COQ <br />MyCorrvaissial SIGNATURES MUST BE IN BLUE INK <br />M\min\sM1azelvsfarms\COhStNClt0t1l l2.doc (07!78!2004) <br />