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Certification: <br /> As an authorized representative of the applicant. I hereby certify that the operatic,i described has met the minimum <br /> requirements of the following terms and conditions: <br /> L All necessary approvals from local go\ernmem ha,,c heen applied 101-(Section 34-32.5-1 10(1)(a)(Vill). <br /> 2. fo the best of my knowledge.all significant,valuable and permanent man-made su-ucture(s)in existence at the <br /> time this application is tiled,and located within 200 feet of the proposed affected area have been identified tLi, <br /> application (Section 30-32.5-1 l5(4)(ci.C.R.S.).(NOTE:For I10 operations.the affected area includes all land; <br /> delineated by the permit boundary.) <br /> 3.No mining operation will be located on lands where such operations are prohibited b-, law(Section 34-32.5- <br /> 115(4)(t),C.R.S.). <br /> 4. As the applicant/operator.I do not have any mini„g,e\�ploration operation,,in the State of Colorado currently in <br /> �,iolation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br /> (Section 34-32.5-120.C.R.S.). <br /> 5. 1 understand that statements in the application are being made under penalty of periury and that false statements <br /> made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503.C.R S. 1084. <br /> This form has been approved btu the,'Ebner Land Reclamation Bourd purattant to section 34-32.5-110, C.R.S.. of <br /> the Colorado Land Reclamation Act for the Extraction of Construction Vaterials.Anh alteration or modification <br /> of this form shall result in ti <br /> n nt•permit issued on the altered or modified fm aornd subject the operator to <br /> cease and desist orders and civil penalties for operatinh without a pertnit pursuant to section 34-32.5-123, C.R.S. <br /> Signed and dated this Aday of February 2022. <br /> Burton Farms LLLP <br /> Applicant/Operator <br /> Signed: �Zl�ilL <br /> Susan Barker <br /> Title: Co-Manager <br /> STATE OF <br /> 5S. <br /> COUNTY OF <br /> J <br /> The foregoing instrument was sworn to, subscribed. and acknowledged before me this <br /> _"ilk day <br /> of February 2022, by Susan Barker, as Co-Manager of Burton Farms LLLP, .Applicant. <br /> Fitness my hand and official seal. <br /> DYLAN SERGIO KAMENICKY % <br /> NOTARY PtJBUC <br /> STATE OF KANSAS Notary Public <br /> MyAppt Exp "m{ - t <br /> My commission expires: <br /> SIGNATURES MUST BE IN BLUE INK. <br /> Burton Farms LLLP Page 8 <br /> Construction Materials Limited Impact(1!0(c))Operation Reclamation Permit application Form <br />