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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 ofmy knowledge, all sil-niticant, valuable and permanent ntan-made structure(s) in existence at the time <br />this application is tiled, and located within 200 feet ofthe proposed aftected area have been identified in this application <br />(Section 34-32.E-1 15(4)(c), C.R.S. ). <br />2 No minim operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.x-115(4)(0.C'.R.S.; <br />3. As the applicantioperator, I do not have any extraction' exploration operations in the State ofColorado currently in <br />yiolatitm of the provisions of the Colorado band Reclamation Act fir the Fxtraction of Construction Materials <br />(Section 34-32.5-120, C.R.S.) as determined throu.:h a Board findin;". <br />4. 1 understand that statements in the application are being made under penalty of perjury and that talse statements <br />made herein are punishahlc as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved hr• the Alined Land Reclamation Board pursuant to section 34 ;? i-112,C',R.S., of the Colorado Laird <br />Reclamation. ict for the Extraction ojC'on.struction .Materials. Aig alteration or modification o/'this.fi)rm shall result in voidirr; at{r <br />permit issued on the altered or modilied,iornr and subject the operator to cease and desist orders and civil penalties.lor operating <br />without a permit pursuant to section 34-32.5-123. C. R.S. <br />Si-ned and dated this day of Au uS ,z'0 <br />/SOB/NS Co.,V STRU(,T/oN LGL P <br />Applicant Operator or Company \ame <br />Signed: <br />I / <br />_a:!? Title: k? <br />State of (lo 0"0a ?¢-- ) <br />/_ ) ss. <br />County of Aa.--z? j&6,9- ) <br />If Corporation Attest (Seal) <br />Siu'ncd: <br />Corporate Secretary or L-quiyalent <br />Tmvn/C'ity'County Clerk <br />The tireuoinu instrument was acknowledged before me this <br />/y?? day of <br />'7 <br />ate. by / ?, // X06 , ;) as ? <br />\o ary Public <br />My Commission expires: l <br />SIGN DTI RES N1l ST BE IN Bl.l V INK <br />YOU must post Sufficient \otices at the location of the proposed mine site to clearly identify the site as the location ol'a