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-8- <br />Certi-. ftcatwn: <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) inexistence at the time <br />this application is filed, and located within 200 feet ofthe 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 fording. <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 I 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••32.5-111, 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 G?Q/Q <br />FYomvr OLATbAlovi t-1.•(' If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed:? <br />Signed: <br />Title: "'46-4- Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of o10,e? ) <br />•1 } ss. <br />County of `'l.?Ylllt.4/ s <br />The foregoin instrument was acknowledged before me this day of 4; , by y <br />i <br />OTAq j;•. <br />Not A ubli:c <br />My Commission expires: <br />0? <br />SIGN pUMU?G .•' •O <br />iF C Qlfj?.1FN BLUE INK <br />You must post sufficient Notices at the location of &d bM osed mine site to clearly identify the site as the location of a