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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) in existence 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 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 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 34-32.5-112,0 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 />(J0 r 09 <br />Signed and dated this 2 Z day of J t't , 2-0 r <br />(? IQ'r?Yq'?LP? C`- . h? ??7? h I L , If Corporation Attest (Seal) <br />Applicant) era r or Company Name <br />! . <br />Signed. Signed: <br />Corporate Secretary or Equivalent <br />Title: IZo C(!J`( ,nn_-J jJ +q"?/?=(yr9rG? Town/City/County Clerk <br />State of.L'6_a C <br />a ) ss. <br />C?(X 6? ) <br />County of <br />The foregoing instrument was acknowledged before rise this day of ? M <br />by -AA-W F?T as se \I_Q _.. - L?11T ---- of -_& ? ? _ _ 1 sSt =?1? <br />`\\\\\\\1111111//////? _'G..S-`; •`? X? (? ???./`- ?----._---- <br />PP S. SrFNotary Public <br />O OTAR U, Ml y Commission expires. <br />.__._,___._.__._._.____._._? <br />.U: k - <br />;,A : p SIGNATURES MUST BE IN RLUJE INK <br />HO \\\.. <br />?,, F OF CO