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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. Tb 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 ofthe 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)0, C.RS.; <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 Boardpursuant to section 34-325112, C.RS., of the Colorado Land <br />Reclamation Actfor the Extraction of Construcdon Materials. Any alteration or modification of thisform 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 34-325423, C.R.S. <br />Signed and dated this day of <br />If Corporation Attest (Seal) <br />Applicant/operator or Company N e <br />Signed: <br />L <br />Si <br />Titled % Y`k?-- <br />State of ,??.,O ) <br />) ss. <br />County of <br />The foregoing instrument was acknowledged before <br />. by 3 L?r 1.+) .c,PAe --7 as <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />me this a '1h day of o <br />of <br />Notary` Public <br />KA71l1/ A. y Commission expires: ?-on <br />V6A _ <br />INK <br />You must post sufficient Notices at the location of the prop me site to clearly identify the site as the location of a