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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) 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. 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, G.R.S. <br />This form has been approved by the Mined Land Reclamation Boardpursuant to section 34-32.5-112,CRS, of the Colorado Land <br />Reclamation Ad 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 modii1ed 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, CRS <br />Signed and dated this / ? _ day of _ 3 RN6a,4Ay <br />'?'C) // <br />y/. e <br />Applicant/Opera r or Company Name <br />' f Lya 4 <br />Signed. <br />Title' Yuma County Road & Bridge TsurtdMining Foreman <br />If Corporation Attest (Sea'!; <br />Signed: <br />Corporate Secre or Equivalent <br />-TOMWI iQ* unty Clerk <br />State of C L1 J) <br />) ss. <br />County of _ <br />The foregoing inst2-um?ent was acknowledged before me this day of J(Ab1i,Br <br />as -of <br />of <br />Notary Public No r'OA <br />My Commissi .- ires: -.? I Z <br />?m <br />?o <br />c.' Z" <br />SIGNATURES MUST BE IN BLUE INK Oc'?f IC <br />?k 0 <br />You must post sufficient Notices at the location of the proposed mine site to clearly identify th ``'°teas e location of a