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I~ECEIVI=D <br />- ~ - FEB 0 2 2005 <br />Certification: eivisian of Minerals and Geology <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 ofmy knowledge, all significant, valuable and permanent man-made structure(s) in existence at Ste 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.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-I 15(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the State ofColorado 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 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 18-8-503, C.R.S. <br />This form has been approved by the Mined Lmrd Reclammtion Bnnrd pursuant to sectimr 34-32.5-11$C.R.S., ojthe Colorndn Land <br />Rec/nmatimr Actfor tke Extraction oJConstraction Materials, Any alteration ar nmdificnlion aJlhis jorm shn// resat in voiding any <br />permit issued we flee altered or nmdifted jnrn: and subject the operator to cease and desist orders mrd civil penalties jor operating <br />rvithou/ a permit pursuant to section 34-32-123, C.R.S. // , <br />Signed and dated this Zq~ day of D~°'br7[~/' , ~. <br />C,o~// ,['_E~1adPG~S~ ~iry~ If Corporation Attest (Seal} - - ~ - <br />Applicant/Operator or Company Name - <br />Signed: ~~ <br />Title: I//Ge.° ~/.c~dhT <br />Signed: O Y .- C" c._...c.-~ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of <br />~~ "~~~ ~~ )ss. <br />County of l=~rtu~wJ's'~ci 1 <br />- ~ °"" <br />The f6regoing instrument was acknowledged before me this _~.___ day of ~e e P/~ <br />,by l~)~l~iQa~ T '~~P/c1i as ~L.C/ -~nl."SiG+[r'lrL1` of -~,~~~l.~t_e.~,~~ <br />Notary Public <br />My Commisslan Expires: <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />M:6ninlshe21v5ronns\CO~,gmclion I @.doc (07Q8@004} <br />