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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 temps 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), <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 Constriction Materials <br />(Section 34- 32.5 -120, C.R.S.) as determined through a Board finding. <br />4. 1 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 ntodiftcatinn of this form shall result in voiding any <br />permit issued on the altered or modified /brut 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. J <br />Signed and dated this 4 day of CC k o e <br />m e./ !L_i' 3 <br />Applicant/Operator or Comp;, ; me <br />Signe I L <br />'/ <br />Title: 1 / <br />State of Vt - 1 LCA,e� -C' <br />) <br />) ss. <br />County of Q Q <br />if Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town /City /County Clerk <br />The foregoing instrument was acknowledged before me this ` 1 `1-'h day of 6 C fo 40 <br />. by I : Roc �li as lY G 1'1 a t L'l. of . ��t%t1c�� t�cT / l Lt,YY r �J <br />SIGNATURES MUST BE IN BLUE iNK <br />• <br />tkt(`i 611,1 JL Lc.I�C'�fco <br />N ry Public <br />My Commission expires: 0 CI- (, uZC I S <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 />