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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,CR.S., of the Coiibrado.kand <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 2 4 t h day of July 2012 <br />Rprii—MiX, nc. <br />Applica t/Operato pany N <br />Signed: <br />Title: <br />State of <br />ss. <br />County of(V� <br />The foregom instnunent was acknowledged <br />by 22 <br />this ; 3 ` t <br />Sylvia <br />M. <br />Hooper <br />If Corporation Attest (Seal) <br />Signe <br />rate Secretary or Equivalent <br />Town/City /County Clerk <br />day of " 4- <br />Ndary Public <br />My Commission expires: l <br />IOr1 a f <br />S RES VUeS ST BE IN BLUE 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 <br />