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-8- <br />Certiffeatton: <br />As an authorized representative of the applicant, I hereby certify that the operation desenbed has met the minimum requirements <br />of the folio«~ing terms and conditions: <br />i. To the best ofmy knowledge, ali significant, valuable and permanent man-made siructure(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 34-32.5-115{4}(e}, C.R.S-). <br />2. No mining operation will be Located on lands where such operations are prohibited by law <br />(Section 34-32.5-1 15(4}(I), C.R.S.; <br />3. As the applicandoperator, I do not have any extractianiexploration operations in the State of Colorado currently in <br />violation. of the provisions of the Colorado Land Reclamation Act for the Extract~ian of Construction Materials <br />(Section 34-32.5-120, C.R.S.} as determined through a Board finding. <br />4. I 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 hfined Land Reclamation Board pursuant to section 3d-32.S-11.2,GR~, of the Colorado Land <br />Reclamation del far the.P.xtraeNan of Construction Materials. Any operation or rnodifumtion of this form shalt result in voiding any <br />permit issued en the altered or modified f©rm and subject the operator to cease and desist orders and etw`t penalties for operating <br />without a permit pursuant to section 34-3~ 5-12, ~ RS. <br />Signed and dated this ~~~ day of -`t~oVdEtliL$~- __~. <br />W~r~c-~ r ~n.~2.JwS. Z~_~L~ <br />Applicantl4perator ar Co acne " <br />Sigmed• <br />Title: ~ p• ~ ~ .,~ al ~~,~ Z" <br />If Corporation Attest (Seat} <br />Signed: <br />Corporate Secretary or Equivalent <br />TownlCity/County CIcrk <br />State of (,~?t-cl/~'~~~ ) <br />} ss. <br />County of _..__._~G~'2 L~.._______.___-__.} <br />`lie faregain.g in~irum~ent was acknowledged before me this ._._.._ ~ day of __ ~'~ ~'~ 7 <br />`..s- <br />t. Notary Public <br />-~ <br />`:,~ ~ fj : ~ - ~ .' , r'. My Conutllssion expires: ~ v~.'-~D ~,- 2O„(f~ <br />__._ <br />~~ ~~, ..r <br />`,, ~., ~.. ~ F SIGIYATL3I2ES ML; S`I` BE I~ BG[; ~. I!~ K <br />~~ Z FC=.x•.n:? <br />~y S <br />-,A-.~..____~.: <br />