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-6- <br /> Certification: <br /> As an authorized representative ofthe 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)(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 man-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)(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 Board pursuant to section 34-325-111,C.R.S.,of the Colorado <br /> Land Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form 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 34-32.5-123, C.R.S. <br /> Signed and dated this 24-Lh day of -4'PIZ(l-- S6 U) <br /> Oldcastle SW Group,Inc.dba Four Comers Materials <br /> If Corporation Attest(Seal) <br /> Ap lic t/O erato <br /> 3/1 <br /> By. ��r-+- 12. By: <br /> Re 4 rce& Environmental Manager Corporate Secretary or Equivalent <br /> Title: /� Town/City/County Clerk <br /> State of 001C r ) <br /> )ss. <br /> County of ' <br /> The foregoing instrument was acknowledged before me this day of c , <br /> by Ma-l� 2 ��Q4r �as 59UV-C4 D(ck' `mil-Ps(-06a)-4P <br /> dl�a CL-PM <br /> 4 <br /> ROBIN L McDERMOTT �C � m_y <br /> NOTARY PUBLIC Nota Public <br /> STATE OF COLORADO �' <br /> NOTARY ID 20104007481 O 2. 16 �3� <br /> MY COMMISSION EXPIRES 03H J <br /> 0/207! My Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />