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-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, atl significant, valuable and permanent man-made structure(s) inexistence 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 <br />(Section 34-32.5-115(4xf), C.R.S.; <br />3. As the applicandoperator, 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 Construction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Boazd finding. <br />4. I understand that statements in the application aze 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 form has been Approved by the Mined Land Reclamation Board pursuant to section 34-32.5-]12,C.RS., ojthe Colorado Land <br />Reclamation Act jor the Ernaction ajConstructwn Materials. Any alteration or modiJlcatlon ofthis jorm shill result imvoiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penaltle3••foioperaturg <br />without a permit pursuant to section 34-32.5-123, C.RS. ~r~' - , <br />-y .' .~ <br />Signed and dated this ~~'C \R day of ~ ~C'Eh~~~ a. b Opp <br />Continental Materials Corporation <br />ApplicanUOpetator or Company Namc <br />If Corporation A[test (Seal) _ 1~ ~ ._ <br />Signed: `' J. rr-.~ <br />Title: ~~C'c ~R~S\~rc~~ <br />State of ~~CLlAIDIS 1 <br />ss. <br />County of ~ODR` ) <br />The foregoing instrument was acknowledged before me this ~ / " <br />,1'001,,by -~OS~~If ~U/7 as VItE f~QFS <br />~•1 A K K C\l 1 C HTr: ~ C1 D R.)°0~(' RTE <br />OfFICIAI SEAL -----• <br />ANNEA4IRIE 8 NUSEKABEI <br />~i~STA1E OF 1190016 <br />--- _ _ S.OEll20t1 <br />Signed: G2'~ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />day of J 6Y) /E/11MBE2 ~,/ <br />tiJT of(;DNTiu~)TAL /"/A~7elAlS CIDRto. <br />Notary Public <br />My Commission expires: ~-aa'd S <br />SIGNATURES MUST BE IN BLUE INK <br />M:~nnn~cAare\r3fonm`LOnshuction i Il.doc (Apprm~ed OS/I 1/2005) <br />