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-8- <br />Certlficatlon: <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 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 <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This fora: has been approved by the Mused Land Reclamation Board pursuant to section 34-325-112,CR4, of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials: Any alteration or modification of this form shall result in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penaltles for operating <br />without a permit pursuant to section 34-325--123, CRS. <br />Signed and dated this °1 i" day of y V Ate <br />Applicant/Op or or Company Nam <br />i <br />Signed <br />Title- <br />C PLJ.?i(w(Q r-, PZ 0 (!_ <br />State of (07 `-? LQ- <br />( )Ss. <br />County of _ <br />The foregoingj?p?um?entwa ow edged before <br />Corporation Attest (Seal) <br />*NT <br />r4 <br />S' ed: <br />Corporate Secretary or Equivalent <br />??'•••RO0 <br />4a. ..•...? <br />?O <br />Town/City/County Clerk <br />do i r'day of <br />-wir Wt-O0.. I fee- of <br />Notary Public <br />My Commission expires: Q?ya " el, d o ail <br />SIGNATURES MUST BF, 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