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<br />~- <br />Certification: <br />As an authorized representative of the applicant' I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my Imowledge, al l significant, valuable and petmanentman-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 34-32.5-115(4xe), C.RS.). <br />2. No raining operation will be located an lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicanUoperator, I donut 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 ConshvcGon Materials (Section <br />34-32.5-120, C.RS.) 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 1H•8-503, C.RS. <br />Signed and dated this day of July 2 0 04 <br />High Plains Sand And Gravel, LLC If Corporation Attest (Seal) <br />Applicant/Operator or Cotapa~ Name <br />Signed: Signed: <br />Robert C< Pittington, Jr. <br />Corporate Secretary or Equivalent <br />Title: Manager Town/City/County Clerk <br />State ~ COLORADO 1 <br />Cam of LARIMER ~ ~~ <br />Ty <br />The foregoing instrument was aclmowledgcd before me this day of July 2 0 0 4 b <br />Robert C. Pittington, J~,q Manager ~ High Plains Sand And-Grav~l, <br />Notary Public <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />Mtminlihvelvd'mma~Camnuetim~ ns.da tia~srzom~ <br />g•d Ib6E 699 OL6 JJB'~9 '~ 4dt°P~@ZI <br />~, <br />dOS~i0 t.0 9S i~C <br />