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As an authorized representati%c 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 this <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-1 15(4)(c). C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-11 5(4)(t), C'.R.S., <br />3. As the applicant, operator, I do not have any exu•action'exploration operations in the State of Colorado currently in violation <br />of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Matenals (Section 34-32.5-120, <br />C.R.S.) as determined through a Board finding. <br />4. 1 understand that statements m the application are being made under penalty of penury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503. C.R.S. <br />This fnrnr has been approved ht' the Mined Land Reclamation Board pursuant to section 34-32.5-112,(. R.S., of the Colorado <br />Land Reclamation Act for the Lvraction of Construction Materials. Anr alteration or modification of tbi.c farm shall result in <br />voiding air'i, permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties <br />fir operating without a permit pursuant to section 34-32.5-123, ('.R.S. <br />Signed and dated this Z? day of cIG. 7,0O5 <br />Applicant/operatoror Company Name <br />Signed: 49? - ====== - <br />Title: C o O <br />State of <br />County of <br />ss. <br />If Corporation Attest (Seal) <br />SiIoned: <br />Corporate Secretary or Equ <br />Town/C'ityr'County Clerk <br />The foregoing, instrument was acknowledged before me this :t s day of w, 1eL i <br />by r u. L'?> w ?' I 7- t-1 as e e c,. <br />?r <br />' 4P' <br />biz; <br />??TqSIGN1A'R'RI:S MUST 131' IN 131.1 i. INK <br />Notary Public lS , <br />My Commission expires: <br /> <br />Office of Office of <br />Mined LAM Reclamation Denver • Grand junction • Durango Arlive and Inactive mines