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0 Certification: <br />-8- <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 form has been approved by the Mined Land Reclamation Boardpursuant to section 34-32.5-112,GR.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 />without a permit pursuant to section 34-32.5-123, C.R.S. <br />-`?-? Zo l d <br />Signed and dated this S day of <br />• <br />4LA!P0.¢`(G GD-f-C A ,?nc• If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed: Signe <br />Corporate Secretary or Equivalent <br />Title: Vr °?` 1 y??%S?_ ??9? Town/City/County Clerk <br />State of CJ _Q? ) <br />ss. <br />County of `7Pv g n>rl ) <br />, <br />The foreg4?40po instrument was acknowledged before me this 5 ?? day of AU ?P u Si- o?G / 13 <br />by y 141 1+e r P- as d4 T LAJQS r- 61 of <br />\?????uu Uillll/ l <br />\\\????\Pg, STEPh,?Notary Public <br />C , OZPR Y - My Commission expires: <br />O: 'Z? G :O <br />U <br />CP. PV : ?0SIGNATURES MUST BE IN BLUE INK <br />You'f }??t?? t fit ent Notices at the location of the proposed mine site to clearly identify the site as the location of a <br />r 11