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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 following terms and conditions: <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 law <br />(Section 34-32.5-115(4)(f), C.R.S.; <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 <br />made 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 Board pursuant to section 34-32.5-112,C.R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding 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 k !S *! n day of (VI e. ?q to OF <br />HALL-IRWIN CORPORATION <br />Applicant/Operator or Compa Y Name <br />Signed- <br />If Corporation Attest (Seal) <br />Title: Zd <br />State of Ca ?Q (ae O <br />. ? ss. <br />County of ...... lQ......... _.....) <br />`Fhe f€pregoing instrument was acknowledged before me this .------?5_±_k ---- clay of <br />----------- - ----------- <br />by.. t._fi -- - -?'-?-` --- - --- - - as ---------- --.4.-. ------- _.._..._.-..-- -_ .. <br />Signed: 4mv-, " <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />of -- i-T ?,,, o ?,P a r5!;. QA <br />Notary Public <br />oQ?¢os,aL?aQ <br />My Commission expires: .._'......`....... 2`j).0.................... <br />4 <br />X na` <br />0 ®? ?Jo ® SIGNATURES NEST BE, IN BLU1? INK <br />0 4V