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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 applicantloperator, I do not have any extractionlexploration 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 Boardpursnant to section 34-32.5-1l2,C.R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Material& 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 day of ^? t?l ST ZUoB <br />1 d G-24le SW Cq,-p c1 P , Mc. , PFA : 1:?o"r Corners If Corporation Attest (Seal) <br />Applicant/Operator or Company Name Mato v-1 9[5 <br />Signed: kv? r Signed: <br />Corporate Secretary or Equivalent <br />Title: 1?"C_r'd Re"4"L Q1- Town/City/County Clerk <br />State of <br />n ) ss. <br />Coun <br />The foregoin??//i__nstr,??u#mentA`,`as acknowledged before ?e this <br />Pueoll- PC? <br />4 day of _aO <br />® K• _FIT?,.., of&W ..9?wc, als <br />expires: <br />SIGNATURES MUST BF IN BLUE INK