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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 requirements of the <br /> following terms and conditions: <br /> I. 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 the <br /> applicant/operator and the persons having an interest in the structure that damage to the structure is to be compensated for by <br /> the applicant/operator(Section 34-32-115(4)(d),C.R.S. 1984,as amended),then mining may occur within 200 feet. Proof of <br /> an agreement must be submitted to the Office prior to the decision date.) <br /> 2. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32-115(4)(f), <br /> C.R.S. 1984,as amended); <br /> 3. As the applicant/operator, i do not have any mining/prospecting operations in this state of Colorado currently in <br /> violation of the provisions of the Mined Land Reclamation Act(Section 34-32-120,C.R.S. 1984,as amended)as determined <br /> through a Board finding. <br /> 4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br /> 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 Alined Land Reclamation Board pursuant to section 34-32-112,CR.S., of the Mined Land <br /> Reclamation Act. Any alteration or modification of this fora►shall result in voiding any permit issued on the altered or►nodif►ed <br /> fora► and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to <br /> section 34-32-123,C.R.S. \n <br /> Signed and dated this day of <br /> Fremont Paving & Re i-Mix, Inc If Corporation AtIcst(Seap <br /> Applicant'O ato r Cc np ny Name <br /> Signed: Signed: <br /> 'orlx>fut ecretary or EquiNalent <br /> Town/City/County Clerk <br /> Title: AJ- <br /> State of fig!, ) <br /> ss. <br /> County of nt 041 A ) <br /> The foregoing instrument was acknowledged before me this //- day ofbk <br /> f <br /> by Nhia r\.1 asPq 41 of <br /> of lic <br /> My Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br /> JODI D SCHREIBER <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20064001792 <br /> "Cu};vitSSION EXPIRES OCTOBER 6 2022i <br />