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-8- <br /> _ertific�tion: <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 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(4xf),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 1 misdemeanor pursuant to Section 18-8-503,C.R.S. <br /> This fonn kas been approved by dire Mined Land Reclmnadon Board pursuant to section 34-32.5-112,GR&,of the Colorado Land <br /> Reclamation Acifor the Eztnaclion of Construction Materials. Any alteration or n ood#kahm oftkis fornn skaQ result in voiding any <br /> permit hwed on the altered or nw Died fonn and subject the operator to cease and desist orders and civil penal for operating <br /> without a permit pursuant to section 34-32.5-123,GRS <br /> Tf� <br /> Signed and dated this day of .1 LA jFo <br /> Wyatt Redi-Mix Company If Corporation Attest(Seal) Iy <br /> Applicant/O <br /> p <br /> era <br /> tonpr Company Name <br /> /f <br /> i 1 <br /> Signed: Sigd/ <br /> Corporate or Equivalent <br /> Title: PresidendVice-President Town/City/County Clerk <br /> State of Colorado ) <br /> )ss. <br /> County of Jackson ) <br /> The foregoing instrument was acknowledged before me this C1I%- day of .fir., <br /> -?a!-q,by V,c-6cLf d f_W��+�- t a g, +was des -,-f� 4 Sg,,,�j� of Wyatt Redi-Mix Company <br /> PV Notary Public- <br /> My f - <br /> ,�p,FtY e <br /> gyp+.. •.��� Commission expires: 5h0 I Ile <br /> AMANDA L <br /> HANSON SIGNATURES MUST BE IN BLUE INK <br /> You m •�• otices at the location of the proposed mine site to clearly identify the site as the location of a <br /> My CongrrsW E#u 06/02016 <br />