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-8- <br />CertiC-cation: ~ <br />As an authorized representative o:f the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. 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.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.R.S.; <br />3. As the applicanu'operator, I donot have any extraction/exploration operations i~~n th.e 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 pf perjury and that false statements <br />made herein are punishable as a Class i misdemeanor pursuant to Section 18-8-5031, C.R.S. <br />i <br />This form has been approved by the Mined Land Reclamation Boardpursuant to section 34-3¢.5-112,GR.S., of the Colorado Land <br />Reclamation fief for the Pxtraction of Construction )1laterials. Any alteration or modification f this form shall result in voiding any <br />permit issued an the altered or modified form and subJect the operator to cease and desist orders and civil penalties far operating <br />without a permit pursuant to section 34-32.5-723, C.1t.S. <br />Signed and dated this S~._ day of ~ ~~ ~ L. , ~ ~ O <br />~./~~C,A~ ~D(„)0~/7'yf [f Corporation Attest (Seal) <br />Applicant/Oper o ompan Name ~ <br />I <br />Signed: - Signed <br />Clp.rporate Secretary or Equivalent <br />Title: _~~"'t~~-SS/O/t/G~ , .~ /S% ~~- ~ Town/City/County Clerk <br />State of._~JOF-~ ~~.____________) <br />} ss. <br />County of .._._ ...' .. ._~~'~--}-._.......--- ..............._....___... ----_- <br />) L <br />i <br />`1`he f2;re g inst_ m. t was acknowledged before ,fie Phis _-_-- ~--._..-.----.......__-- ci <br />(n y / j ''. <br />_......-_., by _~;#~.C~--1. _(~%"~'~ n ------------ as _-- _r"(1iY1;(_t~j_S! ~'nl <br />=,. ~. <br />-_ ~ ~. <br />y' _ <br />_ ~~R <br />'^ _- /'~ <br />SICY~ia~rt.Ti~z~s ~rrl~r. r~~J Il'4 I3Y..til'; T~iI{ ~ <br />i <br />My Commis ton expires:.,__,.._-. -_-~ -_ . _... ____._,.....-__..._... <br />