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8- <br />Certif"icadon- <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 sttvcture(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 34-32.5-1 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 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/opera[or, I donor 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 Extraction of Construction Materials <br />(Section 34-32.5-120, C.R.S.) as deternrined through a Board finding. <br />4, I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This farm has been approved by the Mined Land Reclamation Board pursuant to section 34-31.5-I12,C.R.S., ojthe Colorado Land <br />Reclamation Act for the Extraction ajConstracdon Materials. Any alteration or modijica!!on ojthisjarm shall resuU in vold/ng any <br />permit issued on the altered or modified form and subject the operator to cease and desist ordrrs and civil prnalties for operoting <br />withoat a permit pursuant to section 34-32.5-123, C.R,S <br />Signed and dated this ~~ day of 7~A.n n ;~, 2 Fil/ 7. <br />Gregory Larson <br />Applicant[Operator or Company Name <br />Signed: <br />Tile: Onmwr [~narat nr <br />1'own/City/County Clerk <br />Stateof~i~~lts ) <br />ss. <br />County of _~j2, l_ ~i ,a S j <br />The foregoing instrument wajs acknowledged before me this __S"`L't' day of __ ~~-u~~,~l,' <br />2(SOZ• by _~~ S GS-t _ as Y t? ~~ .'C^C ~oY of __ ~/.L>'SDvt/F %-l <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Notary Public ~ ~ ~, i; ~ '' <br />My Commission expires: <br />SIGNATURES MtiST BE IN BLUE INK <br />,j. <br />~L <br />M:MmnisWrcWaf,mn`r'rnuinclion 112.J<K (nppnvee nsn Inr>nst <br />