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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) 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)0, C.R.S.; <br />3. As the applicant/operator, I do not have any extraetiontexploration 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 I 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.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 permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this day of & d4 <br />_162 1 1 L?o??vT <br />Applicant/Operator or Company Name <br />Signed: <br />Title: /0 <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of -0-C, 10 r'Lcto <br />SS. <br />County of ..._L.- .. ............_.._ -) <br />---......._ <br />The fCirego€rig instrument was ac lcro _edgru berLre t.. t._ .._jv -........_. nab. of .... MCI rOh <br />................... - <br />by 0t-c,?2 ?.. ? as ._Cha n-,cam- ................. -- of --L e ' { .- <br />_ . ----- - - -- -- - _.- ?J- b <br />p yr? m I' SS! ? S <br />`Y17 <br />- KotaryT. tiiblic <br />-My Coibmission expires: <br />............. ... ........... <br />S.IGNAn-RES MUST CSf--JN I3I. VE I..