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rtifice i n <br />.8- <br />As an authorized representative of the applicant, I hereby certify that the operation described has nrnet the nwtimtan requiremerB 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 34-32.5-1 15(4)(c), 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(4xI), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the Stale 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 />Thu form has been approved by the Mined Land Reclamation Roard pursaam a seed-n 34- 325-JIZCR.S, of the Cohnado Land <br />Reclamation Aea for the Detraction of Construction Materials. Any alteration or modlrwadon ofthis farm and/resah in voiding any <br />permit issued on the ahered or modlfmdfa m andsabjedthe operator m cease anddesisl orders ondcisilpenal tinjor operating wm4oN <br />a permit pursuant to section 34 -32.5 -113, C.R.S. <br />gned and dated this _j_Q <br />t _ day of )O.2 (' e. x Ae'! 00 <br />Moores Mininq, LLC. <br />ApplicanUOperatoror Company Name <br />Signed: _ Ir to' <br />Title: Reregistered Agent <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretay or Equivalent <br />Town/Cih' /Cmmtv Clerk <br />Statcof Colorado ) <br />ss. <br />Cmauv of Mesa t <br />The foregoing instrument was acknowledged before me this nd day of 17a.t.Q.mwf , <br />by hen Moores mad V C(aiq Vows as 2 s� iefal Nlptc of 1imm Ndr in0 <br />PV..% 6(\Qu \hR Lo <br />.. .. . .... •Cs Notary Public <br />TRACT <br />S VAN LOAN My Commission expires: 11 2,1(10 <br />• 9 •. <br />SIGNAT N BLUE INK <br />M ennwuew.r , cwtinm iron(A� 105:ll: 2W5) <br />