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-8- <br />Certlftcation: <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 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 applicantloperator, .I do not have any extraetionr`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,Nined Land Reeiamatiou Board pursuant to section 34-32.5-112,GRS., of the Colorado Land <br />Reclamation Act for the .Lactractlon of Construction Materials. Any alteration or modification of this form shall result in voiding any <br />permit issued an the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permitpursuant to section 34-32.S-I13, CR.\S. <br />Signed and dated this ~ ~ day of ~ -~`~ ~ ~~ b ~G <br />Applicant/Operator or Company Name <br />Signed: ~~__ __ <br />If Corporation Attest (Seal} <br />Signed: <br />Title: ~©° ~~~r_~t~?~`~ <br />State of 5~! ~~-b~ __ ) <br />SS. <br />County o.f ~2Y1Y11 /t~ /'1 ..__~...) <br />Corporate Secretary or Equivalent <br />Town~City/county Clerk <br />'I'h.e foregoing instrument was acknowledged before me Leis _~~~ rt ciao of_~~ 8 izy/~1Z~; Zug <br />_-..., by /~ ~ ~Z t.( 5 fond as Gn~~ ~tt'vz~'r' of ~c ~ b~~=iii ~3--~ ~tS L t~ - <br />• <br />* ~ NA7HAN A BAFrIDN ~° ~ <br />,~ ~ * Notary Public <br />~~ NOrARTPUBLIC ~~ <br />• <br />• <br />SfAiF OF 50UiH DAKOTA ~ ; IVIy Commission expires: ?. ~ ~ ~ ~_____ <br />SIGNATi3RES il~itiS7 BF; I'ti Bt:U1~ )<l~`K <br />