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-8- <br />Certification: <br />As an authorized representative of* the applicant, f 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 applicanti'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 <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 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 an r <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. &S. <br />Signed and dated this day of aV 'Ll 2009 <br />Group , SMC., <br />01dc4t4tc. SW <br />dl a_ rOur CornerS-141,%1e1;wlz If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed: m ?;/A Signed: c h rn ??? <br />f IV <br />Corporate Secretary or Equivalent <br />Title: ?er\¢rAl /??11 nrt1sr _ Town!City/County Clerk <br />State of <br />) ss. <br />County of_;'! <br />i <br />The foregoing instrum t was acknowledged beforeZ this day of <br />by ? lC <br />7- Otte /3-i+A171C"L. !i7`/i /,InL <br />'CRY <br />My <br />S1(;NA VRFS :191 5T BF IN HLVE INK