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-8- <br />Certlftcation: <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) inexistence 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 />JSection.3432.5-1-20, 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 Mixed 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 mods, ([cation of this form shall result in volding any <br />permit Issued on the altered or mod Fed 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 Eighth day of July 2008 <br />Lincoln County <br />ApplicantlOperator or Company Name <br />Signed: <br />Titie:Land Use Administrator <br />State of Colorado County of ._Lincoln <br />.?.__.-- <br />The foregoing instrument was acknowledged before me this _V 8 -tYdav of <br />_ , by <br />of <br />Julv, `2008 <br />LOA M CRAWfORO dg':? .Q ) <br />Notary Public <br />My Commission expires: _1n„_? <br />SIGNATURES MUST BE IN $I,UE INK <br />r? <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/CiCountyCle <br />as <br />NOtory ?ubNc t o P?? <br />sta.acaorado <br />If Corporation Attest (Seal)