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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 <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) 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)(f), 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 34-32.5-112,0 RS, of the Colorado Land <br />Reclamation Act for the FUracdon of Construction Materials. Any alteration or modifuadon of this form shall resuh in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penafties for operating <br />without a permit pursuant to section 34-32.5-123, -RS. <br />Signed and dated this day of A u Ws ? .z 040 <br />AO&Ns 6*vsrRUGr1oA1X44 P <br />Applicant/Operator or Company Name <br />Signed: 2A'n:1L& <br />If Corporation Attest (Seal) <br />Signed: <br />Title:2d.C,24 h?? <br />State of <br />) ss. <br />County of '4A-nanS.9- ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this 4ty- day of <br />4421,by R4-rwL11 AL. as (?P.r«r..?.el ? ??G? o /?d(1.i15 Cd-sZS7?'uC?/hc?I, <br />No Public <br />My Commission expires: 7 - /0 - /3 <br />SIGNATURES MUST BE IN BLUE INK <br />You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a