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-8- <br />Certiffcatlon: <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 structures} 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 aperation 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 applicantloperator, I do not 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 M/ned Land Reclamation Boardpursuant to section 34 3~.5-112, C.RS., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials Any alteration or modification of this form shall result in voiding any <br />permit issued on the altered or mod fed 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 />t- <br />Signed and dated this a' $ ,day of _ ~ ~L~rnb~.C' a2 ~ <br />ApplieantJOperator or Company Name <br />If Corporation Attest (Seal) <br />~V <br />Signed: ~oc1r>>e.~~ ~ESoJr'C.~, ~G. <br />Title: ~r~eS~ ~Yl-~r <br />State of _~p~rQ~o ~"_`__} <br />ss. <br />Signed: ` ~ _ r~.~-~~. <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />~~ <br />`The foregoing instrument was acknowledged before rrte this _._~___ day of `~Q_[~~_~1~'--~__ _~, <br />d D_~ 7> by __._.~Caf~~Lc''~.--- C e. y1 tvc,l.l _ as ~ re S ~ d ~,r~ ~---____._. w __-__ o f _~A n~n,~,~1 ~ f.~d,Sc-C.~e g ,~ 1C_. <br />~~ tary Public <br />•:n <br />DANA <br />~~~ 1~ ommission expires: <br />SIGNA'TL?ltES MUST ~QE INK <br />MY COMMISSION E>~IRES: <br />Aupigt 13~ 2011 <br />