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0 Certification: <br />-8- <br />As an authorized representative of the applicant, l hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best ofmy knowledge, all significant. valuable and permanent man-made structure(s) in existence at the time <br />this application is tiled, 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)(1), 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 fur 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 pet-jury 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 bt, the Mined Land Reclamation Board pursuant to section 34-32.5-112,GR.S., of the Colorado Land <br />Reclamation : t ct for the Extraction of Construction ,1laterials. Atq alteration or modification of this form shall result in voiding an t. <br />permit issued on the altered or modified form and subject the operator to rea.se and desist orders and civil penalties J'or operating <br />without a permit pursuant to section 34-32.5-123, C.R. ti. <br />Signed and dated this day of r.= t:. - <br />i <br />ApplicantiUperator or Company Name <br />1?3!2C? <br />Signed: ?-? rn t1 <br />Titlc: C%JaJc r <br />State of <br />Ss. <br />t'ounty of - - -- - _.1 <br />"1 he foregoing instrument was acknowled cki. <br />r? <br />by !tc !mot' - s»:.C_ X CC?cS?cL''- <br />I1'C'otporatiun Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town,'City./County Clerk <br />day of __1..?c? ?4e ?........, <br />7 nC , <br />Notary Public. <br />My commission expires: <br />• <br />%0(:N \ 11 MIS Nil `.I ItF IN till I• I`h