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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.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 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 Board pursuant to section 34-32.5-112,C.RS., 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 akered or modified form and subject the operator to cease and desist orders and civil penalties for operating wdhout <br />a permit pursuant to section 34-32.5-123, CRS. <br />Signed and dated this day of ? 443W Oo <br />da-A COU/y i V <br />Applicant/Operator or Company N <br />Signed: L <br />Title: 6L V COd?I PI / 151O/v&-.4- <br />If Corporation Attest (Seal) <br />Signed: <br />State of ) <br />ss. <br />County of (I t ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this _ '? ? day of C4-oi ? , <br />by r( as :?y1 cc,, G'-""u of <br />P , A <br />L <br />Notary Public <br />My Commission expires: / - I I - <br />SIGNATURES MUST BE IN BLUE INK <br />M:\min\shareNsforms\Construction 112.doc (Approved 05/11/2005)