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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 requirenimts of <br />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 this <br />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 applicant/operator, I do not have any extraction/exploratimr 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 made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Tkis form has been approved by tke Mined Laird Reclamation Board pursuant to secdan 34-325-112,CRS, of A Colorado Land - <br />Ralamation Actfor doe F-vbvcdon of Comarxcdon Materialx Any alteration or modif ication of skis form skall r4oin voiding any --- <br />permit issued on the altered or modifwadfmm and subled die operator to cease and desist orders and C"Penawwj;or opedit, »kJlrow <br />a permitpursuantto section 34-32.S-123, C U _ <br />Signed and dated this a3 r day ofd <br />Name <br />Applicant/Operator or;; <br />Signed: <br />Title: e5, C?nT+ <br />State of <br />County of )ss. <br />The f??orffe__going instrument was acknowledged <br />by as <br />-rd <br />If Corporation Attest (Seal) <br />Signed. ' <br />Co rate Secretary or Equivalent <br />Town/City/County Clerk <br />My Commission expires: o / <br />r= <br />SIGNATURES MUST BE IN BLUE INK - <br />M\mioWre\VdW=\Comwcrioo IIIdoc (Approved 05/11/2005)