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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)(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 applicantloperator 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. 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. 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 for 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 permi pursuant to section 34-32.5-123, C.R.S. <br /> Signed and dated this day of z5Z 1 <br /> Cornerstone Materials LLC <br /> If Corporation Attest(Seal) <br /> Ap ' ant/Operator <br /> By: By: <br /> a n e r Corporate Secretary or Equivalent <br /> Titl Town/City/County Clerk <br /> State of W L0 9A DO ) <br /> County of t-1 o wmyJ�j ss- <br /> The foregoing instrument was acknowledged before me this 19 day of � �2 <br /> by 1AN as r tAI J AJQ7C_'2 of <br /> RA MIZ. A-1.5 L-L� <br /> DANEAN A. CHEZEM <br /> NOTARY PUBLIC lic <br /> STATE OFCOLORADO <br /> NOTARY ID#19994035233 My Commission expires: 0 l 0��ZD <br /> My Con;r;;ss;on E.x fires Jena 4,2024 <br /> SIGNATURES MUST BE IN BLUE INK <br />