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-8- <br />Certification: <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) inexistence 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. 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,C.R.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 J9i 11 <br />?.. t6t .<. .. <br />without a permit pursuant to sect 34-32.5-123, C.R.S. <br />Signed and dated this c2A ? ay of s elo n e4 i/145:W, 0? 0 c rt , 4 "? <br />T(fF SdMM /T PR??SEO BRI?F? S? r/ F, C0M?,¢A <br />Zib4 stJl'f'l/N/ j ,BiQfeK T/l• O• If Corporation Atte (Se)% <br />o <br />Applicant/Operator or Company Name <br />?f <br />4Z'X <br />Signed: Signed: t !i <br />Title: A4 e- S /p ex-1 7- <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of GOtoRhd ) <br />ss. <br />Countyof P v ee c.o <br />The foregoing instrument was acknowledged before me this Q IUD day of SF PTE/,%6E-1 , <br />10 , by '3oS1=PH C WELTE as DES I DENT of sumM r R10" TILE C'Q <br />s? <br />Notary Public <br />_ <br />My Commission expires: 3Z.2&011 <br />SIGNATURES MUST BE Ili 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