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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 day of <br />d; C J � I <br />-A; 41 ( 1C <br />Appli ant/Operator or Company Name <br />Signed: <br />Title: President <br />State of a , ! <br />No <br />My <br />SIGNATURES MUST BE IN BLUE INK <br />,243 <br />If Corporation Attest (Seal) <br />) <br />`` ) ss. <br />County of V 6'� , 1,(i. ) <br />r A / <br />The foregoing acknowledged before me this c c day of �,�`t, '� [� 11 <br />2 /, S 1lil"L( '6-,F,• ix i as Tv\e`_ fd -E'4• <br />Corporate Secretary or Equivalent <br />Town/City /County Clerk <br />/1 <br />c/, '47 <br />RONDA1 t n SCHAFER--_ <br />ary Public NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID MMI � 9 bXPtRE S ` 12IOS12018 — <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 />