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-a- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum require? of <br />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 this <br />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 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. 1 understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class I 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 3442.5-112,CRS., of the Colorado Land <br />Reclamation Ad for the Fa*acdon of Construction Materials. Any alteration or modrwadon of this form shag result in vouTing any <br />pe?mitissued ongee alteredor modyu djorm andsub.ketike operator tacease and desistorders andeivilperraXes for operadVndhautt <br />a permit pursuant to section 34-32.5-123, C.RS <br />Signed and dated this 11 th day of July , 2006 <br />• Pelino, Inc. <br />Applicant/Opera Comp <br />Signed <br />Title: <br />by <br />0 <br />President <br />Stateof Colorado <br />ss. <br />County of Chaf f ee <br /> <br />} <br />The foregoing instrument was acknowledged before me this 11 th day of July 2006 <br />Scott Pelino as president of pelino, Inc. <br />04% <br />g?P OTA 9 •??` <br />- ?. <br />Notary Publ <br />My Commission expires: /0 <br />SIGNATURES MUST BE IN BLUE INK <br />(Approved 05/1112005)