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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), CKS.). <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 Recdamatdon Board pursuant to section 34-32.5-112,C-R&, of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or mod fu=ation 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 34-325- -123, C-RS <br />Signed and dated this day of V -�4 I/ f <br />Richard F. Wyatt,Rodney B. If Corporation Attest (Seal) <br />WyaWWyatt Redi -Mix Co. _ <br />Applicant/Operator or Company Name,. <br />Signed: <br />Corporate Secretary or <br />Title: PresidentNics- President Town/City /County Clerk <br />State of Colorado ) <br />ss. <br />County of Jackson ) <br />The forego instrument was acknowled ed before me this o day of <br />070f by t4 as aCE-A4L1 ;22r)--} <br />�noAH A. <br />�ILLF�ORD <br />DEB NOTARY PUBLIC Notai <br />STATE OF COLORADO Cc�rrn r a&02P(0d <br />2_ �� My Commission expires: p <br />I , <br />