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"t;'~ 2 3 ?G0~ <br />-~- <br />Certification: <br /> <br />As an authorized representative of the applicant, I hereby certify [hat the operation described has met the minimum <br />requirements of the following terms and conditions: <br />1. 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 34-32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-1IS(4)(f), C.R.S.; <br />3. As the applicant/operator, I 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 Cohstruction Materials <br />(Section 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 />Tlris jornr has been approved by the Mined Land Reclamation Board pursuant fo section 34-32.5-112,C.R.S., of the Colorado Land <br />Reclamation Act for the Extraction ojConstrucfion Materials. Any alteration or modification ojthis farm shall result in voiding any <br />permit issued on the altered or modifred farm and subject the operator to cease and desist orders and civil penalties jot operating <br />without a permit pursuant to section 34-32-123, C.R.S. <br />Signed and dated this 25th day of <br />Oldcastle SW Group, Inc. dba United <br />Companies of Mesa County <br />Applicant/Opera[or r C mpany Name <br />Signed: <br />Title: U/GQ Presto/L~ty <br />State of Colo <br />County of <br />ss. <br />2005 <br />If Corporation Attest (Seal) <br />v. <br />_: " ~ <br />Si d` ~ ~L <br />orporaofe ~Jecre °OOrkEquivalent <br />Town/Ciry/County Clerk <br />The foregoing instrument was acknowledged before me [his 25th day of Aril ,2005 <br />b Craig Lamberty asp President of and ^N esw roup, Inc. dba United Companies ofMcsa <br />_, Y <br />~M~-tr-c.`- <br />Notary Public <br />My Commission expires: 3 / 2 9 / 07 <br />M:\min\share\vsforms\Conswc[ion 112.dx (07/28/2004) <br />BE IN BLUE INK <br />