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RFc - - <br />(:erti r?y2? ?O <br />Ciy? Z4 0 <br />As an a *WYV tt? "native of the applicant, 1 hereby certify that the operation described has rnet the minimum requirements <br />of the lollowinf?ilypr atQrgtanditions: <br />1. 'I'o the best of m?Qnowledge, 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 34-32.5-1 l5(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)(t), 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. 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,tifined Land Reclamation Board pursuant to section 34-32.5-112,C:R.S., of the Colorado Land <br />Reclamation,t et for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding an q <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 - <br />i <br />K'_. ,_ ' ? 411 Xt 0 ?( if Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed:_ Signed: <br />J .?Y p(/ - <br />Title: Y)I??`?lt^? { ?? <br />State of _?' ?- -- -) <br />Ss. <br />County of <br />.••••'•••BCorporate Secretary or Equivalent <br />MANDI Town/City/County Clerk <br />SMUTS <br />allmsion Bores <br />06/12/2010 <br />The tirregoin instrument was acknowledged before m ct u G day of' <br />?I by of LLf_.? _ cx?c ?cl x?f . <br />r? y <br />No a Pub is - <br />My Commission expires: <br />N11 S] [IF' IN 111 14, INK