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-8- <br />Certiffeation: <br />As an authorized representative of the applicant, I hereby certifythat the operation described has met the minimum requirements <br />of the following teems and conditions: <br />I . 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.RS.). <br />2. No minim; operation will be located on lands where such operations are prohibited by law <br />{Section 34-32.5-t 15(4xfj, C.R.S.; <br />3. As the applicantloperator, I do no#.have any extractianiexploration 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-i 20, C.R.S.) as detetnsined 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 28-8-503, C.R.S. <br />This farm has been approved by the Mined Land Iteclarnatian Board pursuant is section 34-3Z.~I12,GR~, of the Coloreds Land <br />Reclamation Act for tke aetlon of Construction ,Materials. Any operation or n~odtficatton oftltis farm shall result in voiding any <br />permit Issued on flee altered or modified form sad sub,~eet the operator to cease and desist orders and civil penalties for operating <br />without a permp pursuant to section 34-32,5-123, C~Rj S. <br />Signed and dated this _ t ~Z~l,. day of t`~=1~t't/ Ili. j~lQ- ~~- <br />• ~ '~L,-~- t~ y~, ~~ "C ~ /.~ ~t,,r..~~ . 3= e~ ~ . If Corporation Attest (Seal} <br />Applicarttl0perator or Co ame <br />Signed• _____,r Signed: <br />Corporate Secretary or Equivalent <br />Title: ~ ~. ~- S 3 al. ~~ 1 Town/City/County Clerk <br />State of (11~~'4'~ <br />} ss. <br />County of __.-~~. L~..__..___..__.} <br />`lbe foregoing i rus~nt was ac~owledged before see this .. ~~ day of ._ ~'~ eR- .... ~UC?7 <br />Y ~._. <br />~~ ~ ~' '' ` Notary Public <br />'_ - <br />'~ ';,F ~~~ , ' .. s~~ ` IViy Commission expires: _ C ~"~ ~~ 2O1 ~ <br />'•'_ ~ ,~ a ~ ~:` ~ ~ ~ SIfi~iATi~"RES MUST BE CN BLG=E iNK <br />~. <br />• <br /><~.~ F <br />~. ~. <br />~~ ~ <br />