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-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(4xe), CALS.). <br />2. No mining operation will be looted on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4xf), 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 Ad for the Extraction of Construction Materials <br />(Section 34-32.5-120, CLL.) 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 />Ms form has been qp vved by the Mbred Land RwAuwdm Board p wmaat to secdon 34.325-112,GRL't, of &e Colorado Land <br />RedamadbaActforAe Ev&acdom of Cmxs&u m Mahvick Any affivardom orwa ore of Ak formskaff resultln vold* any <br />permit !sawed on the ab! red or mdyW form and suNert the gpern or to cedar and dealst orders and drill penaNim for opffa ft <br />wb*md a perndt pwrswant to serfdom 34-325-123, GRS <br />Signed and dated this U day of e 7 <br />'le Szn d V gave /, L4C <br />ApplicantlOperator or Company Name <br />,?L Z. l4-0 <br />If Corporation Attest (Seal) lf?o Sea-( <br /> <br />Corporate Sectary or Equivalent <br />Title: Managerlowner <br />Town/City/County Clerk <br />State of Co lo rcLd o 1 <br />) ss. <br />County of $czd ) <br />The foregoing instrument was acknowledged before me this $ day of Lao7? Le , <br />ao10.by ?'AA D• 1x'C? as Mayaaaf-Zowv\e,,c ofW Wte Sound ?- <br />°'; Notary Public Gds <br />My Commission expires: / C- / 8-a O l 1 <br />.......... <br />_ , .? SIGNATURES MUST BE IN BLUE INK <br />?.. ? tea, <br />You mnsE j'pv§`t' sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a