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Certification: <br />- 8 - <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 modified 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 1 c( day of ( -tr— <br />Signed: k 02/1.12af,,i-i <br />Title: I /,- c -e <br />Y_v , e 9.' A'�lti,� <br />Signed <br />F4ui C. L ?✓ y d t .df g'��w��:v� Co y If Corporation Attest (Seal <br />Applicant/Operator or Company Name <br />State of Co (p v„-1 (f ) <br />ss. <br />County of q_.( igas, ) <br />The foregoing instrument was acknowledged 00-2 <br />be . e this / day of v <br />,2111, by rl Q 1 5 6 �+ (25 0-cm of- 41m;014 <br />Corporate Secretary or Equivalent <br />Town/City /County Clerk <br />#OTAip z _ <br />0,M Notary Pub ic <br />ybuwo., 44 <br />My Commission expires: <br />mi$% <br />SIGNATURES MUST BE IN BLUE INK <br />