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-8- <br />Certiifcation: <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(4xf), C.R.S.; <br />3. As the applicantloperator, I do not have any extractionlexploration 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,CJL&, of the <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modijtcadon of this form shall resat <br />permit issued on the altered or modi/led form and subject the operator to cease and desist orders and civil pe <br />without a permit pursuant to section 34-3Z 5-123, CR.S <br />Signed and dated this I day of GZ f' <br />Y <br />Wrado Land <br />4 void ieg:any <br />L.. <br /> <br />fo S -? r? G . If Corporation Attest'( !). r' "X?;` ` <br />? <br />A licant/Operator or Company Name "Icy. <br />!? fr? JIB. '?? ,? . <br />Signed: Signed' <br />Corporate Secretary or Equivalent <br />Title: President <br />Town/City/County Clerk <br />State of CO l o ro-d o ) <br />ss. <br />County of A h Q rn o S 6L <br />The foregoing instrument was acknowledged before me this y? day of LL Qi"_ --r,(Tdd A. V-bd-ebra ad o200.by as rPS1de>'1_+ of nr- <br />1 .O <br />40? Z„' r •??fjy? Nom- <br />?blic6l <br /> <br /> My Commission expires' (?'/?c, <br /> <br /> <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