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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 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) 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 34-32.5-1 15(4xf), C.R.S.; <br />3. As the applicant/operator, 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 Mixed Land Reclamation Board pursuant to section 34-31.5-112,0 R.S., of the Colorado Land <br />Reclamation Act for the Fx1raction of Construction Materials. Any alteration or modification of this form shall result in voiding an Y <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to .section 34-32.5-123, C.R.S. <br />Signed and dated this I I a day of `? C <br />O1Jca -.-fle SAW Via- , =r,c. <br />a6A ro4v / l.er„evi /4,Ae+a1S <br />If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed: <br />'title: l iit /41._ I4,t1?, Gehevat MAnA)er <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of Cc?\ c, ado ) <br />) ss <br />County of .4c, <br />The foregoing instrument was acknowledged before me this day of -_5k.-?Prrg" - <br />as C= erg e c r?1 (har,ci T CIE o f _ <,? , i .[,, • ., !?, 7L <br />.1cf ? 4 , by r:, <br />n.", t<'C c IS <br />C1kl 1-[u' CGrner-' <br />Notary Public <br />My Commission expires: -1-/ -Z <br />SiGNATI RES MI S1' BF IN B1,14- INK