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-6- <br />Certification: <br />As an authorized representative of the applicant, l hereby certify that the operation described has met the minimum requirements of <br />the following terms and conditions: <br />1. All necessary approvals from local government have been applied for (Section 34-32.5-111(1)(a)(IX)); <br />2. This entire mining operation will not affect more than 30 acres; <br />3. This mining operation will not adversely affect the stability of any significant, valuable and permanent matt -made <br />structure(s) located within two hundred (200) feet of the affected lands. (However, where there is an agreement between <br />the applicant/operator and the persons having an interest in the structure that damage to the structure is to be compensated <br />for by the applicant/operator (Section 34-32.5-115(4)(e), C.R.S. 1984, as amended), then mining may occur within 200 feet. <br />Proof of an agreement must be submitted to the Office prior to the decision date.) <br />4. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)0, CRS. 1984, as amended); <br />5. As the applicant/operator, I do not have any mining/exploration operations in this 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. 1984, as amended) as determined through a Board finding. <br />6. 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. 1984, as amended. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-111,C.R.S., of the Colorado <br />Land Reclamation Act far the Extraction of Construction Materials. Any alteration or modification of thisform shall result in <br />voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties <br />for operating without a permit pursuant to section 34-32.S-123, C.R.S. <br />Signed and dated this day of <br />The Walsenburg Sand and Gravel Company. <br />Applicant/Operator <br />By:�-44 Z�o <br />i, l <br />Title: <br />If Corporation Attest (Seal) <br />Corporate Secretary or E4&alent <br />Town/City:-'County Clerk <br />State of 17A��a CLD i <br />) ss. <br />County of CLAW <br />The foregoing instrument was acknowledged before me this JA day of Zo 1 - , <br />�1 <br />by <br />The Walsenbur Sand and Gravel <br />' 1_n (as ,m . o f 9 <br />Company. <br />ANN V. CAFFEY J'i <br />NOTARY PUBLIC <br />STATE OF COLORADO Notary Public <br />NOTARY IO M 20144043163 <br />MY COMMISSION EXPIRES NOVEMBER 07.2018 <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />