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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 <br />requirements 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 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. 1 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 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 />Signed and dated this day of I-A W ? DUQ <br />Grand County Department of Road and Bridge If Corporation Attest (Seal) <br />Applicant/Operator or Company N ne <br />Signed: Signed: <br />orp cre qj?v e• <br />Title: Road Superintendent <br />State of Cn oro.An ) <br />ss. <br />County of Gr rnncl ) <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this Z $` day of L. 1', , <br />ZPA by At ri F_ . J?aynt s as ' ' c3md SyT Q.?ivr?cndtrrf of C rand C-0.),n k/yCAk?? rnf' <br />of 1?oa..d and PJr ; dgG . ;y=..; 'r?`"" . <br />- Notary Public <br />t <br />My Commission expires: 'k 2_01 X <br />SIGT ? ,BUST„BE' IN BLUE INK <br />You must post sufficient Notices at the location of'flie proposed mine site to clearly identify the site as the location of a