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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 />I . To the best of my knowledge, all significant, valuable and permanent man-made structure(s) inexistence 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 34-32.5-115(4)(e), C.R.SJ. <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-I i5(4)(f), C.R.S.; <br />3. As the appticanVoperator, I do not have any extractionlexplorationoperations in the State ofColorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Constmction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Boazd finding. <br />4. (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 fosoi has been approved by the Mined Load Reclamation Board pursuaat to section 34-325-I72,C.RS, ajtbe Colorado Land <br />Reclamation Act for the FaTraction oj'Canstrnctian Materials Anp aUeration or modification ojthisform shal(result iu voiding auy <br />permit issued ort the altered or modified farm and subject the operator to cease and Desist orders and civil penalties jor operati+rg <br />without a permit pursuant to section 34-32.5-123, CRS <br />Signed and dated this ~_ day of 4 ~.s~e... btr DO _. <br />Jeffr~~r (,.Schumacher If Corporation Attest (Seal) <br />ApplicanUOperator or Company Namc <br />Signed:6~~~7 ~ - ILL Signed: <br />Title: Owner <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of Ce~~p } <br />ss. <br />County of ~Q,K ) <br />T'he foregoing instrument Gvas acknowledged before me this /. ~ day of .S e~~e..eb / <br />~AOji f1L/t t' of ,~/.~Ir:....~rs...:,6- <br />ZQt~Q• by~~-{f1f~L~-J[~tG.M0.GOt{.r" _ as ~- rl /~ <br />Notary Public <br />My Commission expires: ?'YID 1313 01007 <br />SIGNATURES b4UST BE IN BLUE INK NOTARY PUBLIC <br />MPnrinsMrc`s3fimm`COnsmr~iun I IlAx (A{ry>rw'ed OS/112(MS) LISA L. KLINZMANN <br />STATE OF COLORADO <br />