2012-12-31_PERMIT FILE - M2012051

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-8- Certification: As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following terms and conditions: 1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) inexistence at the time this application is filed, and located within 200 feet of the proposed affected area have been identified in this application (Section 34- 32.5- 115(4)(e), C.R.S.). 2. No mining operation will be located on lands where such operations are prohibited by law (Section 34- 32.5- 115(4)(f), C.R.S.; 3. As the applicant/operator, I do not have any extraction/exploration operations in the State of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34- 32.5 -120, C.R.S.) as determined through a Board finding. 4. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to Section 18 -8 -503, C.R.S. 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 Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34 -32.5 -123, C.R.S. G✓C�irr v l c Signed and dated this .AYl day of �L fu 4114 Sx If Corporation Attest (Seal) Applicant/Operator or Company Name Signed:�� Signed: V�4raL Corporate Secret or Equivalent fill Title: r 1-17f+r� bounty Clerk State of LkoraAu ) I ) ss. County of A l WX0'_ ) The f i g instrument was ad by�� You must post sufficient Notice;