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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, 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 Act 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 modif ed 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 C -2 day of & VU <br />?? - <br />^\ <br />UItO e- C QSS"()YiS q'Q3 4 -Un C. - <br />Applicant/Operator or Company Name <br />Signe <br />Title: 0141r l- <br />State of <br />?-- ) ss. <br />County of ZRCVS 02?? ) <br />P- '4 e-,, 7 <br />The foregoing instrument was acknowledged before me this aAWA day of , <br />QA by Gd yld,j- i cx,v? as W of ZLJtbk E. . <br />SPRY PUB <br />Q• -.lam <br />:n <br />KELLIE L. <br />GREENS ' <br />a'9 •.....•4 <br />Cok- <br />SIGNA <br />If Corporation Attest (Siali; <br />Signed:- <br />Corporate Secretary or Equivalent <br />AA.LA? <br />Notary Public <br />My Commission expires <br /> <br />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