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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 of <br />the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) inexistence 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.). <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.RS.; <br />3. As the applicant/operator, I do not have any extraction/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 made <br />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 Mined Land Reclamation Boardpursuant to section 34-32.5-112,C.RS., of the Colorado Land <br />Reclamation Ad jor the Extraction of Construction Materials. Any alteration or modification of this foam shall result in voiding any <br />permit issued on the altered or modifeed form and subject the operator to cease and desist orders and civil penalties jor operating without <br />a permit pursuant to section 34-32.5-123, C RS. <br />Signed and dated this ~~ day of _1~~GEt~~ ~~d~ <br />Grand Count Department of Road and Bridge <br />Applicant/Operator or Comparry ame <br />Signed: `-" <br />Title: Superintendent <br />State of Colorado <br />County of Grand <br />ss. <br />If Corporation Attest (Sf~al), ;~; :~ ~,~` ~e: <br />. . ,~: ~'~ <br />~'` '~ <br />e~e r <br />Sign <br />Corporate Secretary:or Equivalent; <br />Towt~LCi County~~Ye,~it ~.: <br />'' ic- <br />~ 1 { ~.°s ~ .T'3 <br />i ~ r <br />The foregoing instrument was acknowledged before me this `7 ~` day of ~,/ e.%.., Z ov ~' <br />by Ken E. Haynes as StlRerintendent of Grand County Department of Road and Bridge <br />Notary Public <br />SIGs <br />My Commission expires: ~' ~ / 3 ~Lo /! <br />:UE INK <br />