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-8- <br />• Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has metthe minimum requiraraaris of <br />the following terms and conditions: <br />L. To the best of my knowledge, all significant, valuable and pemranattman-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 identified in this application <br />(Section 34-32.5-115(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)0, C.R.S.; <br />3. As the applicant/operator, I do not have atry 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 Conswction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Board finding. <br />4, I understand that statements N the applicazion are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This jorm has been approved by the Mixed Lard Reclamation Board pursuant to section 34-31.5-IIl,GRS ,of the .:almodo Land <br />Reclamation Act jot the Ia7racrion ojConstructian MoteriaLr. Any aperation or modiJha/ion ojtirisjorm shnllUtout[ im koidii:~,any <br />permit issued on the ahered a modijmdjorm and subject the operator to cease and desist orders andeinil p~aCiesPori opnoti.aXwdFout <br />a permit pursuant to section 34-31.5-I13, OILS ~ ^-~:' ~~ % , ~% <br />Signed and dated this z ( day of ~ 200$ '_ - - -_ - - <br />i • <br />If Corporation Attest <br />Signed: <br />Town/City/County Clerk <br />State of l-f~~orl1~0 ) <br />) ss. <br />County of W n ~ A'-- 1 <br />The foregoingng ((i~n~stn//u~~ rent was acknowledged before me this ~ / S~ day of ~~ /1, ~/ <br />by 'CP.-F^f (9 CQ `LQ BS ~OSh~r/o5 Wtr. GPr Of~R,Q~-~~r/, 1~\vv IiSrp TJ"'' <br />o ,Public G <br />• M Min\shue\nrorw\Comwaion 112 da (Approved OSA 1 <br />y Commission expires: /D~ /~'~~O/,LR <br />INK <br />Corporate Secretary or Equivalent <br />Title: roe ~a <br />