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-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the fallowing t€mm no gQ!4Qw <br />1. To 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 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 taw <br />(Section 34-32,5-115(4)(f). Cr-%$,: <br />3. As the applicantioperator, I do not have any extraction/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclarnaation Act for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Board finding. <br />4. 1 understand that statements in the application are being made under penalty of perjury and that false statements <br />m4dE llmin an pvnlshablip os a Qlass ] 1nl-s n?ji r purSpant t9 ecligr 1$-4-5{13, CA"', <br />This form has been approved by the .ifined Land Reclamation Board pursuant to section 34-32.S-112,C:R.S., of the Colorado Land <br />Reckmad ow Ad forthe Zwrra.Mpo Of CollstrtlWou 1V&er&1X A4j, alt"&1 oU or X0&01 4d0J; Qftlt€>s fQrJ" 44yrouft i s vnmw any <br />permit issued on the altered or modified 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 _ day of V(,?A? <br />r <br />i lUus1-Ei W, If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br /> <br />Title:- 6WA & <br />Signed: N/A-- <br />.Secretary or liquivalent <br />State of <br />ss. <br />County of <br />Touui!CitylCounty Clerk <br />1`he foregoing instrurronnt was acknowledged before me this ,.__.????day c>f _..? 1•??? .... _. 1 ? <br />by -? --?v%vi?- -- -v -_-.-._.... <br />o0l <br />r , a "? ,? rj xY f G' r t; Publi <br />M Commission expires <br />ss1GNA` uRES MUST RE' IN SLUE INK