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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 ofthe 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)(£), 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. 1 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 i misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved by the Mined Land Reclamation Boardpursuant 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 permitpursuant to section 34-32.5-123, C.R.S. <br />ytc, <br />Signed and dated this day of M a,, c. <br />Applicant/Operator o ZCOMY e <br />Signed <br />Title: <br />7 <br />State of eo !o V.,P° <br />) ss. <br />County of <br />The foregoing instrument was acknowledged before me this <br />2001. by CtirrY L 2ov.t. - ?_ as /411 <br />????rr.rrrr?r <br />?. <br />FRI Epp ??? <br />+ <br />?'''. <br />? PPY 0- <br />Z <br />r <br /> <br /> <br />r 00 0 :: <br /> <br /> <br />O w <br />"low <br /> <br />2vd? <br />If Corporation Attest (Seal) N° Se.Ad <br />Signed: -- e C <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />My Commission Expires 10/17/2010 <br />My Commission expires: _........... SIGNAIC?"US ?13t.,iJE IN <br />0,i;'q ,E' O, <br />y ?h day of /tla •' C?A