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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 fmding. <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 I 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 fir operathig <br /> without a permit pursuant to section 34-32.5-123,,J, C.R.S. <br /> Signed and dated this (a day of ) Ouevn&,v , <br /> Aggregate Industries, WCR Inc. <br /> If Corporation Attest(Seal) <br /> Applicant/Operator or C Name <br /> Signed. Signed: <br /> Corporate Secretary or Equivalent <br /> Title: k4 1 4&D �`�Q I�1 C� 1�'l�YICP ✓ Town/City/County Clerk <br /> State of C-O'J 'CAC) ) <br /> '. )ss. <br /> County of J Q_ ._�(Z 5yyn <br /> The foregoing instrument was acknowledged before me this la day of N OUem L V <br /> o�l2L�,by :�d j,.n ( l'Lr1 as i� (�_WA2.P M of 1 a <br /> SAW GREGA <br /> NOTARY PUBLIC Notary Public <br /> ' STATE OF COLORADO <br /> NOTARY ID 20174007757 <br /> My COMMISSION EXPIRES FEBRUARY 21,2021 My Commission expires: a a <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 /> t <br />