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-7- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />Atl necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(VIII). <br />2. To the best of my knowledge, all significant, valuable and permanent man-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.). (NOTE: For 1 IO operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3, No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), <br />C.R.S.). <br />4. As the applicant/operator, I donothave any mininglexpioratian operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of perjury and that false statements rrntde herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-110,C.RS., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modi,Jlcation of this form shat! result in voiding <br />any permit issued on the altered or madifred form and subject the operator to cease and desist orders and civil penalties for <br />operating without a permit pr~rsuant to section 34-32.5-123, C.RS. <br />~"`` ~av c~ 200 8 <br />Signed and dated this ___,~=,. day of <br />If Corporatioa Attest (Seal) <br />Signed: / " <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of `~~~ ` ~ ) <br />} ss. <br />County of.___.~^_~ _._.___._...~_...~) <br />'I`he foregoing instruraxent was acknowledged be€ore n~ this ~._".._.-___ day of _ -- ~ ~~ <br />y <br />otary Public ! , <br />ttily Conunission expires: ~ ~~ <br /> ...NO,p <br /> <br />5IGNA`i'TJRES MUST BE TN BLI:E Ii~tK :~.•~ Off. ~ <br />t0 C <br />:~ ~: ~ <br />~:~ <br />~ <br />~iYw.'• ........ <br />Title: __~C?,(~e~.G-~I - <br />