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<br />-5- <br />Certifioation• <br /> <br />As an authorized representafiive 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 ofthe proposed affected area Dave been identified in this application <br />(Section 3432.5-115(4xeX CRS.). <br />2. No mining operation will be looted on lands where such opeations are prohibited by law <br />(Section 3432.5-115(4xf), CRS.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the State ofColorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 3432.5-120, CRS.) 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 184;-503, C.R.S. <br />This form has been approved by the Maud Land Redonadon Bowl pasawd to secam 34-32 112yGRS, of tie Caronado Lard <br />RedmnaftmuAdforMeE autofCoa&ucdmMaw Any aftwa&n ormodi admofAkfWmshall resultfitvoWngmry <br />penult issued on tit allmd or mod{ WJbr re and subject the operator to cease and desist orders and dvllpenaltIm for ope adw <br />without a per W pursuant to section 34-325-123, C.RS <br />Signed and dated this 11 day of January 1 2011 <br />Jack Clark, Jr. <br />Applicant/Operator or Company Name <br />Signed: <br />sap& <br />Title, Owner <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/Courriy Clerk <br />State of <br />) ss. <br />O/? <br />County Of <br />l <br />The foregomi instnun yw acknowledged before me this ll day of ?J ?? uQ y <br />0 /I. by {1ArK Jr as jo Ct)/'i ems' of Pr r J?YX?s <br />SAh '(?tcl.? <br />Y.P. <br />DEBRA R. <br />PONCHAK <br />You <br />Notary Public l <br />My commission expires: ?- <br />y SIGNATURES MAST BE IN BLUE INK <br />at the location of the proposed mine site to clearly identify the site as the location of a