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•8- <br />Certificattou: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best ofmy 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 applicantloperator, 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 Bard 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 i4- 31.5- 112,C.RS., of the Colorado Land <br />Reclamation Act forthe Extraction of Construction Materials. Any alteration ormodifrcation of thlyform 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 />f�/r 2009 <br />Signed and dated this � day of , <br />All -Rite Paving Redi -Mix, Inc. <br />Applicant/Operator or Qgrnpany a e <br />Signed: <br />Title: _C' • ����QS <br />State of Colorado <br />� ss. <br />County of _L!`O--21a 1,I__. —_�) <br />If Corporation Attest (Seal) <br />Signed: <br />Corp rate Secretary or Equivalent <br />Town/City/County Clerk <br />Tic foregoing instrument was acknowledged before me this � _ day of _ <br />b o� YL_ as �/f of r. lid% r <br />oE�lsr��o»u;�«s <br />,NOTARY FUB�.IC - <br />S TA?E Of COIQfJ.DO Nouiry Public <br />mmission Upires 2114110 ,/ <br />My Commission expires:._. v2 - `"r -'Q- /- <br />SIGNATURES MUST BY IN HLUE INK <br />