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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 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 ruining 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. 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 Mined Land Reclamation Board pursuant to section 34- 32.5- 112,C.R.S., 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 penalties for; operating <br />a ,�,:,r.r,in. ✓Fib / , <br />without a permitpursuant to section 34- 32.5 -123, C.R.S. <br />Signed and dated this I _� day of ll'. 0 e- M b 2r 7- Z OD <br />k9p h cal Ccm5ku.c*n( <br />Applicant/Operator or Company Name <br />pffirv�l Ed Mann MINE - / <br />Title: President <br />State of d 6 ( ) <br />ss. <br />County of �.�5 '� ) <br />Town/City /County Clerk <br />n�yThe foregoing instrument was acknowledged before me this (� day of �) tC_ _ I I P,( , <br />plW 1—, by :aa A . ,, � bC ,`: e as W e5\V� e.XA+ of � � + S _ ► � XaL, <br />MAU ku L�� <br />ota ublij <br />My Commission expires: L a <br />;.` <br />Y . <br />SIGNATURES MUST BE 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 <br />If Corporation <br />V K f�d ''� <br />w i <br />f4 <br />i <br />- J. <br />,, { r <br />_• =y or E quivalent <br />