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- 8 - <br /> Certification: <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 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 finding. <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 form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.R.S., of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form 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 /> ^. �I ).'01 GR-�v <br /> Signed and dated this �3 i' ! day of v t V i)e r' , �. 0/ •As QO�A OSA <br /> 0 <br /> Oldcastle SW Group, Inc. dba United Companies If Corporation Attestl'A.1) � O.: 5 <br /> O• <br /> Applicant/Oper: • •r Cpany Name 410% s <br /> •.. f <br /> Signed: ///�„. A _ _ Signed• :: �4 <br /> 'eter .ie_mu,i. V <br /> Corporate Secretary or Equivalent <br /> Title: Assistant Secretary Town/City/County Clerk <br /> State of Colorado ) <br /> ) ss. <br /> County of Mesa ) <br /> The foregoing instrument was acknowledged before me this �3 ed day of 0. 01..)Pf (CI7 <br /> , by Peter Siegmund as Assistant Secretary of Oldcastle SW Group, Inc. <br /> dba United Companies <br /> GENEVIEVE M.BLECHA °411-61/L)A( /J/ <br /> NOTARY PUBLIC <br /> STATE OF COLORADO Notary Public <br /> NOTARY ID#19914003259 <br /> My Commission Expires April 4,2019 <br /> • <br /> • My Commission expires: 4pri �9 <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 />