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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)0, 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 Mined Land Reclamation Boardpursuant 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 J?A l? ?. 0 D <br />a - <br />p 9?0 -e ?e1 If Corporation Attest (Seal) Applicant/Operator or Company Name <br />?f <br />Signe _ ```ApltttotOANpii? <br />" <br />??..,?x .K. DJ <br />Title: v L? V(zt$ t Avc cF o-PS ='' V?•N O T A R 1't <br />T <br />o? C:r P_ D Ger??df ? IK\ G <br />S;A't'??PUBLI <br />State of g10! <br />) ss. 0• F . • • PP <br />COLO <br />??rnrrnnnttaa? <br />County of Exoit <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The fo Ding instrument was acknowledged before me this day of _ _ 02d D ? <br />bY <br />Notary P lic <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK