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. ? <br />-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)(0, 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 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 ally <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />Yvithout a permit pursuant to section 34-32.5-123, CAS. <br />Signed and dated this nd . day ofn(-) ())}P-!"' <br />i E)('C aU 0113"1 -L C N EX <br />Applican ,jeratororcolipN a J' <br />!vG' GORP''C9` <br />e ?•. <br />2 ?' • ' 9a <br />. 4 <br />m :z <br />Signed: C <br />:l?ADO .• :?? <br />Title: '?r e S I t31 n <br />Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of... CC) 10 ro"J C) ) <br />County ?a (.1+ ) ss. <br />The foregoing instrument was acknowledged before me this nd day of O f`', l r? Uc ?' <br />by Ord S. ZE?1r1P „ as P ren i C1P nt _ of Prige i 510 E va n <br />Upropoe % 16 biic <br />mission expires: SIGNATURE You must post sufficient Notices at the location of ty identify the site as the location of a