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-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) inexistence 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 Constriction 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 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 -112,C &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 modifred 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 1 <br />Wyatt Redi -Mix Company <br />Applicant/Operatorpr Company Name <br />Signed: >J <br />If Corporation Attest (Seal) <br />Corporate Secret6y or Equivalent <br />Title: President/Vice-President Town/City/County Clerk <br />State of Colorado ) <br />) ss. <br />County of Jackson <br />i6 da <br />The foregoing instrument was acknowledged before me this q y of <br />by ': t i- 4 r. +f 4 u� �,� +w_4as }i FS �►;, 4t� 1 t� ; of Wyatt Redi -Mix Company _ <br />Notary Public, <br />Y P`jeli.. My Commission expires: _ `'/r d i 1P__ -_ -__ <br />AMANDA L i <br />HANSON _ Y SIGNATURES MUST BE IN BLUE INK <br />You mu9W;;p!ff0Wotices at the location of the proposed mine site to clearly identify the site as the location of a <br />My Commission F.*es 0511012016 <br />