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8- <br />Certification: <br />As an authorized representative of the applicant,l hereby certify that the operation describedhas met theminimum requirements of <br />the following terms and conditions: <br />I. To the best of my Imowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located w7thin 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-I 15(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by ]aw <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicanUoperalor, l do not have arty extraction/exploration operations in the State oC Colorado currently in <br />violation of the provisions of the Colorado Land Rxlamation 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 [he application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 1 B-S-503, C.R.S. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 3J-31.5-I ]l,C.R.S, ojthe Colorado Land <br />Reclamation Actjor the EX1faCllOn ojConstruction Materials. Any aherarion or modifu:aSon ojthisjorm sha![resuh in voiding any <br />permit issued on the a@ered m modiJiedjorm and subject the operator to cease and desist orders and civil penalties jnr npcrotixgxvhnut <br />a permit pursuant to section 3J-32.5-123, C.RS. <br />;= <br />Signed and dated this 17 day of <br />Colorado Quarries, Inc <br />ApplicanUOperalor or Compam Name <br />Sign <br />Tide: President <br />State oC CO ) <br />ss. <br />County of Fremont ) <br />4 <br />Clerk <br />The foregoing instrument was acknowledged before me this 17 day of July 2006 <br />b, Bill Tezak as President of Colorado Quarries, Inc. <br />`sss)uunu,n, t <br />~,``` 3o~8t1~ ' 'N <br />~ -- 3 --My Con <br />SIGNATURES M[~T~°`IIN,~~.(iF',yNK <br />S1.4aunkhvc'valomu~Comwa~on ll. Jec (Approved 05/11/2005) ////// P/ly5'tj ~~~ <br />2006 ~ - <br />If Corporation Attest (Seal)` -T <br />Signed: <br />expires: ~ /~ (/6 <br />i <br />