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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 Boardpursuant to section 34-32.5-112,C.R.S.1, 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 modified form and subject the operator to cease and desist orders and cjCW_?enalties_for operating_ <br />without a permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this /O day of 2011 <br />k r_1_61 ( nxp_i PS :2 ? <br />Applicant/Operator or Company Name <br />Signed: Z& ?_?4 <br />Chris opher L. Varra <br />Title: President <br />?O ) <br />State of 0/0 <br />J ) ss. <br />County of IAL9,1 U ) <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me is day of <br />0?, by as as of et t- <br />OQ_ <br />Notary Public <br />My Commission expires: o <br />fT f? y <br />SIGNATURES MUST BE IN BLUE INK <br />You musf post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent