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<br />-~- <br />Certification: <br /> <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 />I . 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 34-32.5-1 I5(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-1-5(4)(f), C.R.S.; <br />3. As the applicanUoperator, 1 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 (Section <br />34-32.5-120, C.R.S.) as determined through a Board finding. <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 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />C~ <br />Signed and dated this ~ day of X00 '; •. !t ~~: <br />~~ <br />C~ - <br />r 1; - <br />WESTERN MOBILE SOUTHERN INC. •• , <br />~ subsidiary of Lafarge Corp. If Corporation Attest(Seal)';,'~ ~' r <br />Applicant/Operator or Company Name : %;,. '~ ~ ' ~ <br />Signed: ~- <br />STEE EN J U NSIDE <br />Title: Asphalt/Aggregate Business Unit Manager <br />Signednn: ~~,,...,,// <br />/d ~orpora a ~fcretary or Equivalent <br />State of C;d7vy~ ) <br />ss <br />County of ~~ ~.tZd~6~ ) <br />Town/City/County Clerk <br />The fore oing instrument w, s acknowledged before me this ~~ day of //~~K-~/j' <br />by ~ ~v:~o . as .~e.~iti+ 7 fi~~ my/ of . ~Yd~it~ri ;~YIZ~-~` e~~~t / <br />•.~ /~ ~~, ~ <br />MARGARET F. CASTLEBERRY ~LA/e~P~f7-P~-~ <br />NOtaryPubliC Nota P blic <br />State of Colorado ~/ <br />My Commission expires: 7 ~.~ o?G`~3 <br />SIGNATURES MUST BE iN BLUE INK <br />M:VAM$HARE\VSFORM5138.7COIl MP O]/10/99 <br />