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-8- <br />Certi.Ctcation: <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. Ta the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this application is filed, and located ~v7thin 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-i 15(4}(e), C.R.S.). <br />2. x\To mining aperarian 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 applicantioperator, I donot 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 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 Mined Land Reclamation Board pursuant to section 34-32.5-112,0RS., of the Colorado Land <br />Reclamation Act for the Extraction of Co~:struction 1ylaterials. Any alteration or modification of this form shall result in voiding any <br />permit issued an the altered or modifed form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this oZ ~ 5 day of ~ E'(,~2r~be,C' a0 0~ <br />~ Applicant/Operator or Company Name <br />If Corporation Attest (Seal} <br />~v <br />Signed: ~Ocln~,`~ ~,tSoJ~c.~S ~f1L. <br />Title: ~'r~S~ ~~``(1} <br />State of ~'o ~r~ D } <br />) ss. <br />County of _ jar ±'~.2N~ __._ } <br />Tawn,~City/County Clerk <br />The foregoing instrument was acknowledged before me this .~~ 5_ day of ~Q (~t_.~\ ~-~ , <br />d D~~> by __. _~ ~ C,~C1A.rC~ ~ y1 rvGll _ as ._~ r-e S ~ (1 ~,r~ t ^ .._.__ of ._~ ~nr~~1 ?~e ~c~.StZ.-e ~ 1C . <br />-°" tary Puhlic <br />•:c~ <br />DANA ° <br />CREGO ~ ommissian expires: <br />Signed: ``~~.-~- ~ - r~~-~~-~, <br />Corporate Secretary or Equivalent <br />SIG~iATtiRES MUST ~'~11~ IItiK <br />MY COMMISSION EXPIRES: <br />August 13,_2011 <br />