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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 3432.5-115(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 pequry 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 3442.5-11ZC R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteradon or mod Jkation of this form shaft result in volding any <br />permit issued on the altered or modifurd form and subject the operator to cease and desist orders and ciw7 penalties for operating <br />without a permitpursuant to section 34-32.5--123, CR R.S. <br />Signed and dated this l -? day of `Wa'`a'? <br />.;-) 0og <br />/a?d? s f ?a S Ui & ro uR -TOL dl0f- F'D"r- 607e"s ?afz°r, ?s If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed: <br />Title: ??SOa?i?N???none /?L???if1J`? <br />State of 0O1o <br />ss. <br />County of",-e-gr -.) <br />"Me tbrego' g instrument was acknowledged before me this day of <br />My <br /> <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />ZDD? <br />Public h?T <br />Iaa <br />-D? <br />SIGNATURES IVIUST OF, IN BLUE, INK