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0 <br />-8- <br /> <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 teens 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 ofthe proposed affected area have been identified in this application <br />(Sectioit 34-32.5-115(4)(e), CYLS.). <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), CLL.; <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 Conmuction 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 falso statements <br />made herein are punishable as a Class I misdemeanor pursuant to Section 18-&503, C.R.S. <br />This farm has been approved by the Mined Land Reclamation Board pursuant to section 3I-325-112,CR.S, of the Colorado Land <br />Reclammdon Act for the Jctrac don 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 subjecs the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-325-123, CAI <br />Signed and dated this 29th day of October 2010 <br />James L. Treat <br />If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: <br />State of Colorado I <br />ss. <br />County of Chaffee <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before methis -? day of <br />Aaaby L. Treat as Applicant of <br />ti;,...'A <br />Q, ?°• ,• <br />• Notary Public <br />N. •?V `G•: op My Commission expires: 0 <br />Iff <br />Ofi CoSIGNATURES MUST BE IN BLUE INK <br />You mAtpost sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a