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-8- <br /> CerU&atien: <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 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. 1 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 fonts has been approved by the Mined Land Recannation Band pursuant to section 34-32.5-112,CRS,of Ae Colorado Land <br /> Recantation Act for the Extraction of construction Materiats. Any aheradon or modijkaflon of this four shill result in voiding any <br /> park Issued an the altered or modifted font and subject the operator to cease and desist orders and clvil penalties for operating <br /> witkout a permth pursuant to section 34-32.5123,C.RS <br /> Signed and dated this ad _day of <br /> Aagregate Industries-WCR,Inc <br /> If Corporation Attest(Seal) <br /> Applicant/Operator or C ame <br /> Stgn 7 Signed• <br /> Corporate Secretary or Equivalent <br /> Title: Regional General Manager Town/City/County Clerk <br /> State of ) <br /> )ss. <br /> County of V ) <br /> The foregoing instrument was acknowledged before me this day of <br /> by t:-rt" as Aka& ` of <br /> 9R TEOF� Notary Public <br /> NOTARY D 1981101 55 <br /> y11 7 2D11 <br /> My Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br /> You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a <br />