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~S~s~ chlt/ ~0~(__ ~ ~~ <br />~ ~ <br />Certification: <br />S~ ~j11ct~~ie-~~ <br />-ZoO~-(;O~ ~ <br />-7- <br />JAN 1 1 Z0O1 ~, <br />Division of Reotematlon, <br />' Mining and Sa/etY L~ <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />Collowing teems and conditions: <br />1. All necessary approvals from total governrtrent have been applied for (Section 34-32.5-110(1)(a)(VIII). <br />2. 'Co the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 fee[ of the proposed affected area have been identified in this application <br />(Section 34-32.5-I 15(4)(e), C.R.S.). (NOTE: I%or 110 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-I 15(4)(t), <br />- - . - _ C.R.SJ._ - -- -- - - - - _ -- -- - - <br />4. As the app6cant/operator, I do not have any mining/exptoration operations in the State of Colorado c»rren[ly in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction ofConstmction Materials (Section 34-32.5-] 2Q C.R.S.). <br />5. I understand that statements ut the application are being made under penalty ofperjury and that false statements made herein <br />are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This form has been approved by the Mined Land Reclamation Roard pursuant to seMion 34-32.5-!]O,C.RS., ofthe Colorado Lard <br />Reclamation Act jor th¢ ExtractJon of Construction Materials. Any alteration ar modification of this form shall result in voJding <br />any permit issued an /he altered or modified form and subject the operator to cease and desist orders and civil penalties for <br />operating without a permit pursuant to seMion 34-32.5-123, C.RS. <br />Signed and dated this ale ~I day of ~B-i~-/n~z~ .2 c9(% <br />~)~' - <br />Ritchevs' Redi-Mix Concrete, Inc. ~~ ~ If Corporation Attest (Seal) <br />ApplicandOpemtor ~ //~/~~7~ <br />Signed: ~ ~ i ~. ~~~,/ ed~ '-1--t`a <br />C.~~ ~ / / " C rporate Secretary or Equivalent <br />Title: !honer TownlCity/County Clerk <br />- - -- - --- - ~ - - - - - --- - - - _ = t - -` - -- - <br />Stateof Colorado ) <br />ss. <br />County of Phillips _) <br />'Che foregoing instmment was acknowledged before me this .2 ~ !/h day of ~G'r^~~^~^{~_ 26~ ~ , <br />_, by _3e~r~ B.irchay as Owner/Operator of <br />Ritcheys' Redi-Mix Concrete, Inc. <br />Notary Public : ~. ' ~ - 1 ~_ <br />My Commission expires: 2-22'03 ~ i' ~_ <br /><. ~ <br />%a _ `+.._._..~~~.`. ~~ <br />SIGNATURF,S MUST' BE IN BLIJF. INK ``'•-' ~ ~ ~~ <br />Mdmin~shAre\vsfurms'{onstruc[ion 110 (Approved O5i112W5) '" -' <br />-~ r <br />