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- x - <br />Certification: <br />As an authorized representative of the applicant. I hereby certify that the operation described <br />requirements of the following has met the minimum <br />terns and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the tirne <br />this application is tiled, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-11 5(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-1 150)(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 I misdemeanor pursuant to Section I8-8-503, C.R.S. <br />This firm has been approved by the Alined Land Reclamation Board pursuant to,cec•tion 34-32. i-112,C.R.S., of the Colorado Land <br />Reclamation.-I e7 for the Extraction ul'C'u?tstrtu tiun ;tfateriul.?..41q alteration or modification of this form shall result in voiding a»p <br />permit issued on the altered or modified firm and subject the operator to cease and desist orders and civil penalties for operatitt,;, <br />?vithout a permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and data{ this day of <.Ja-yj 0 D <br />Ftt11\h K LeeY) e, )r <br />Leone Sn,-id LL <br />ApplicantiOpperator or Company Name <br />Signed: ~ <br />Title: 11 A Al 11 ? e r <br />State of L.al o,< 400 ) <br />ss. <br />County of l Ifi? Y1,1 Ma S ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this 5[j day of jj/,dQt ZQ f(W <br />U U> by - aV-0i A. ,(c,4 (u ll',A) as NU /AKsj of 0 Cu <br />Notary Public <br />My Commission expires: 0//I) SIGNATURES MUST BE IN BLUL INK <br />I f C )rporat ? r tte. ( Seal ) <br />Signed: <br />You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a