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8- <br />Certification: <br />As as authorized repr+esentarive of the applicant, I hereby certify that the operation describedhas and the minimumregtrirements of <br />the following terms and conditions: <br />1. To the best of my lmowledge, ail significant, valuable and permancntman-made structure(s) in existence at the time this <br />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 mining operation will be locatod on lands where such operations are prohrbited by law <br />(Section 34-32.5-115(4xf), C.RS.; <br />3. " As the applicant/operator, I do not have arty adractioduarploration operatiums in the State of Colorado crurentiy in <br />violation of the pravisioas of the Colorado Land lieclamation Aa fa the Extraction of Construction Materials. <br />(Suction 34-32.5-120, C.RS.) as determined thrargh a Board finding. <br />4. I rmdastand that statements in the application are being made under penalty of pcjury and that false statemenus made <br />ha+ein are punishable es a Class 1 misdemeaaorpursuent to Sedian 18-8-503, C.RS. <br />Th8 form has boas approved by the Mined Laid Ra:lamadox Board parsaant to seapiox 342.5-112,GRS, ojtha Colorado Laid <br />Rtdanea#oxAdforbieExtradionojConsa~NoxMatata[x AxyaLtcadoaorxrodylaadioxojdktrjarnrskaaroxdl6evoidbegmry <br />peaarhiragad on tlu aCersd or mo~Rsdjorm andsxbfed the oprrator to oea+e and daitt orders andeivfiparabder joropa~Fngxlfhord <br />a porn&pxrsamd io sexAtox 34.32.123, C.RS. <br />Signed end dated this 4th ~, of ' .Tanuary 2007 <br />HOLCIM (US) Inc. <br />Applicant/Operator oar Ce®pany Name <br />If Corporatien Attest (Seal) <br />Siae~LC~PI~-~/~~ <br />Tltle: QUARRY / RASd MATFRTA7 S ANArFR <br />State of l '~~.4~~7~~~,/~"~ 1 <br />County of 17'~~~?~) ss. <br />signed: m <br />A,,,1. C ~,.., rn•S..d <br />orporate secretary <br />The foregoing /instrumrent was arlmowledged before me this ~~'~! day of _Q~Ll., <br />by ~J,GP.LQ/~ ~ `T~ly as ~~i~~~~~Drcr~~~i.~- %~~ ~/St _+ <br />Q O <br />~~ <br />Notary Public <br />My Commission expires: o'jf'JD 8 <br />SIGNATURES MUST BE IN BLUE INK <br />M~mahhuaWdu~cmMmovcum 112aoc (npprovad 03/11n00s) <br />