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-8- <br />Certincation <br />As an authonmd representative of the applicant, I herebyceilify that the operation dcscnbed has met the minimum rcquircmcnts <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made Mntcture(s) in existence at the time <br />this application is tiled, and fixated within 200 test of the proposed allcctrd area have been identified in this application <br />(Section 34-32 5-1 15(4)(c), C.R.S.). <br />2. No mining operation will be located on lands where such operations arc prohibited by law <br />IScoion 34-32.5-115(40. CRS . <br />3. As the applicant: operator. I do no( have any cxtraction, exploration operations in the Statc of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act fix the Extraction of Construction Materials <br />(Section 34-32.5-120, C R.S ) as determined through a Wiard finding <br />4. 1 understand that statements in the application are being made under penalty of perjury and that false staten-inis <br />made hercnn are punishable as a Class I nusdenx:anor pursuant to Section I8-8-503. C.R.S. <br />This form has berm approved by the Mined land Reclamation Board pursuant to %ecdom 34-32.5-112,('. R. ti., of the Colorado land <br />Reclamation .der for the Extraction of Construction Nateria/c .1n_y alteration or modification of this fora shall result in voiding ani• <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalries for operating <br />without a prrmir pursuant to.wWom 31-32.5-121, C. R.S. <br />Signed and dated this _?;-- _____day of _-- <br />O(dtas+(e 5 W V?o?p, Znc . <br />dbw F-our C'oer%erb MaAe-l" Z <br />Applicanti(lperator or Company Name <br />If Corporation Attest (Seal) <br />Signed: 1r_ 7 /Y1 - 4"_1_ <br />Title: 1C??? "Al. Elul, 6e?+er4%( Ma.% ev- <br />State of ?.c( -- - --- - -) <br />) ss <br />ounly of, <br />Signed: e? h?a ?. , l?Y?? ??'? <br />Corporate Secretary or E:yuivalcm <br />'rown,carcounty ( lerk <br />Me foregoing instntment was acknowledged before me this ? day of `r. 1_ +..,ti,?•[ _ - <br />•?' ? , by as 1 Lr?'tYi: t t' ? - of G.',%AC"1 1.C._.`« C t'?a ?h <br />Notary Public <br />My Comm nssnon expires 1 I t.' <br />til(.`AII RFN SII SI HF' I` HI t h I`h