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-8- <br />Certirication: <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)(£), C.R.S.; <br />3. As the applicantloperator, 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 Board pursuant to section 34-32.5-112,C.RS., of the Colorado Land <br />Rec4mation 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 />witliout a permit pursuant to section 34-32.5-123, C.R.S. 1 <br />K, <br />Signed and dated this day of A, 1.6v-5 5 T 2007 <br />(,r,Ved ?rr?a??h, c5 O? INe::5e y If Corporation Attest ?s <br />W o. <br />ApplicantlOperat or Company Name ,. `?• <br />Signed: Signed: L <br />Corporate Secre ary oc Equivalent <br />Title: _11?P P,-e esq 1`- Town/City/County Clerk <br />State of LaAbo ) <br />ss. <br />County of ,!?6A- ) <br />4 <br />The; foregoing instrument was acknowledged before me this day of _?/u ?Qfiq <br />i i?_ <br />by , .- as // r? of onc n 3 r-? 542 C?,eoc1a .uc . <br />S S,EF.?ruu0 Aoi-4 &Nr,-zn4 G6^c 4tir4Ls orca <br />Not ry ubli <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK ?? ,7?? r =? <br />