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-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby acetify that the operation described has met the mutimtan roquirern rm of <br />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 <br />(Section 34-32.5-115(4xe), 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(4xf), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the State of Colorado csrrendy in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Constrtn;tion 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 made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This for» t Am been approved by the Muted Land Re hma don Board ptrrntant to section 34-32.5-112,GRS, of the Colorado Land <br />Redanadon Act for the F-v&oc" of Cons&ualon Materials. Any awn or mmoddy1cafion of tuns forcer shall res» k w void ittg any <br />perm tissued an Ae altawed or noodifUd fiam atd suAW the opaworto cease and desist orders and clvflpenaNafor gmrd it wftomt <br />a permit pursuant to serrion 34-32.5-123, GR.9 <br />.dtF_/a•.a. ?t ao G <br />Signed and dated this day of <br />Thompson Properties o <br />Applicant/Operator or Company Name <br />If Corporation Attest (Seal) <br />44- <br />Title: Partner <br />State of Colorado p <br />) ss. <br />Cry of Grand o ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this day of ?e?.?ZAe& . ?L <br />by Larry Thom son m as P n of Thompson Properties ©. <br /> <br />SIGNATURES MUST BE IN BLUE INK <br />Signed: <br />1N:WuaW eWew=Ta Wucb= I12doc (App med0511Ir"S)