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. -8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described hasmet the minimum requirements of <br />the following terms and conditions: <br />1. To the best of my lmowlalge, ap 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 proposod affected area have been identified in this application <br />(Section 34-32.5-L tS(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4xf), C.R.S.; <br />3. As the applicanUoperator, I do not have airy extractionlexploration 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, l understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class t misdemeanor pursuant to Section 18-8-SU3, C.R.S. <br />This john bas been approved by the Moved Load Reclamafion Boord peerseeant to section 9J-3~S-112,CRS., ojtJu Colorado Land <br />Reclamation Act for the F.a7radion of Coeesdudiorr Materials. Any aheration or seodifecatiore ojtkis form shall resah in voiding any <br />permit issered on tbeabered or ~nodiJud jornt o><d subject flee opa+ator to cease and desist orders msd civil paraltieaJor operaMrg n~Lad <br />a eeer»rlt awrswaeet to section 3J-32.S-123, CRS <br />Signet <br />• <br />Appl <br />Signer <br />Title: <br />State of~~f.~.7Y'L~~, ) <br />my <br />s <br />07 <br />ss. <br />Cotutty of ~~%k~G(. ) <br />The foregoing instrument was aclrnowledged before me this x mk day of ~ 1 S• , <br />bY. -~(~/~.~,1~! t`~ Z ~.. Lf~~ as .,;i,~ 1~Y-'~'z~ ~fu>c_;4..~ of 1 ~~' <br />.~ Y. . <br />~., <br />L ; <br />Notary <br />•. <br />= ••. ..' <br />My Commissi ~• <br />a,yt~rn~wr r~• cznsrmto <br />SIGNATURES MUST BE IN BLUE INK <br />b1:hn,olshere~vsforsmlCoNWnion 112.d« (Approved OSIl IR005) <br />ao~~ /o?y7 <br />