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-8- <br />Certification: <br />As an authorized representative ofthe applicattt, I hereby certify that the operation described has met the minimum requvements <br />of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and perniattent man-made structure(s)rn 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.SJ. <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-i i5(4~tj, C.R.S.; <br />3. As the applicanUoperator, I do not have any extraetion/exploration operations in the State of Colorado currerttly in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction 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 aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This jorm has been approved by the Mined Land Reclamation Board parsuant to section .?4-32.5-IIZ,C.RS, ojthe Colorado Land <br />Reclamation AMfor the Extraction ofConstraction Materials. Any aGterotion or modiJieatlon of [hisform shall result in voiding any <br />permit issued on the altered or modiJled form and subjeM the operator to cease and desist orders and civA penalties for operating <br />whhout a permH pursuant to section 34-32.5-123, C.RS <br />Signed and dated this __~ ~~__ day of r I I , ~. <br />Ritchevs' Redi-Mix Concrete,~nc_ <br />ApplicandOperator or Company Name ~ <br />xG~r~~. <br />Signed: -„~M~ _1~ , ~ , ~ DOJO ; <br />Title: Owne r I Op~at o r <br />If Corporation Attest (Seal) <br />i~~~ - <br />Signed: <br />Corporate Secretary or Equival <br />State of C'o /y.-ado ) <br />ss. <br />County of ~~ ~ ~/~~ ) <br />The foregoin ' strument was ackno /wledged before me this ~ day of <br />20L~ 2, by 2r^ ~Pi~c Li,e~rq as 1llcld~ir of <br />Town/City/County Clerk <br /> <br />Notary Public ? ,.v * ' r • ; <br />.. O'_ -___ t. <br />My Commission <br />SIGNATURES MU5T BE iN BLUE INK <br />M;YmnISTaMvsfome~COnahmtion 172,k,c (Appro~cd 05/11/2005) <br />