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-6- <br />Certification: <br />As an authorized representative of the applicant, I 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)(UQ); <br />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 man-made <br />structure(s) located within two hundred (200) feet of the affected Iands. (However, where there is an agreement between <br />the applicantloperator and the persons having an interest in the structure that damage to the structure is to be compensated <br />for by the applicantloperator (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)(f), C.R.S. 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 Boardpursuant to section 34--32.5-11I,C.R.S., of the Colorado <br />Land Reclamation Act for the Extraction of Construction Materials. Any alteration or modo icallon of this form shall result to <br />voiding any permit issued an the altered or mod led form and subject the operator to cease and desist orders and civil penalties <br />for operating without a permit pursuant to section 34-31.5-113, C.R.S. <br />Signed and dated this day of June 2017 <br />Oidcastle SW Group, Inc. dba Uniled Companies <br />Appli t/ rotor <br />By: <br />Pete J. S egmund <br />Title: Assistant Secretary <br />State of Colorado <br />SW cRo�. <br />p -o k <br />.:a <br />SEAQ, <br />'•CORP"G. <br />If Corporation Attest (Seal) <br />h <br />Corporat Secretary or Equivalent <br />Town/City/County Clerk <br />) ss. <br />County of Mesa ] <br />The foregoing instrument was acknowledged before me this `� !� day of June 2017. <br />by Peter J. Siegmund as Assistant Secretary of Oldcastle SW Group, Inc, dba <br />United Companies <br />GENEVIEVE-M. SLECHA ll�rli cw-f. f dJ t4 <br />NOTARY PUB! .. <br />STE,TC QF COl , n,300 Notary Public <br />NGTARYID#199�4t.i. '.�5,tt C <br />My Commission 1=x ires Apra ., .10 i 9 My Commission expires: I <br />SIGNATURES MUST BE IN BLUE INK <br />