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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 applicantloperator, 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 Board pursuant to section 34-32.5-112,C.R.S., of the Colorado Land <br />Reclamation Actfor 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 />Signed and dated this In day of 4 o r-Y h ?,? 2p O <br />0 <br />Duckels Const., Co, dba Yampa Aggregates <br />Applicant/Operator or CoMA-- <br />Title: Signed: 0 P j- e S <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of (I lON'el 60 ) <br />ss. <br />County of ) <br />The foregoin i strume t was acknowledged before me this T day of?_celw4e Z pro <br />? <br />by 4 ? as /1,e S i? ,z of _ P "C /r Cam, T ?? <br />.yy: .,? ,? r ??a r r r r rr •?I ??.u, <br />r ` `RrJ s <br />vr?. r <br />Pub <br />' My Commission Expires <br />' ?°•.•p.••'° E ' My Commission expires: May 21, 2012 <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