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<br />-~- <br />Certification: <br />• <br />n authorized representative of the applicant, I hereby certify that the operation <br />~ribed has met the minimum requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected azea have been identified in this application (Section 34- <br />32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Hateriale (Section 34-32.5-120, C.R.S.) <br />as determined through a Board finding. <br />4. I understand that statements in the application aze being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 16-8-503, C.R.S. <br />Signed and dated this ~.3~day of //er~.A~ , ~~. <br />Pete Lien & Sons, Inc. dba Trans-~olorarln Concrete <br />Applicant/Operator or Company Name <br />Title: Asst(Sec=etar Treasurer <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of South -Dakota: ) <br />ss <br />County of Pennington ) <br />~_a `- / <br />The foregoing instrument was acknowledged before me this ~~ day of ~CQmM.1Q~` ~ ~~-',-~~, <br />by Craig Grotenhouse _ as Gc~r/CPrrara,-y Tre carer of v r L• r~=o+--~-r-.~+~-. - <br />db Tr~s~elbrado ~vncret <br />Notary Ribli2,_...-;.-.; - <br />_~ ' <br />My Commission expires: ~_'"T ~L-~~Z- <br />SIGNATQRES MAST BE IN ffiIIE IN1C <br />01/02(96 24ZiFC0.112 <br />• <br />