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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has me[ the mirrimum <br />requirements of the following terms and conditions: <br />1. To the best of my lmowledge, all significant, valuable and permanent man-made structure(s) in existence 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-I15(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.R.S.; <br />3. As the applicanboperator, I do not have any extraction/exploration operations in the State of Colorado currently in <br />violafion of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board fmding. <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 />Signed and dated this 13-}h day of 1-ebr Uo r U 2~ `~ = ' : r,- • ;~~ ~r, C; •, ~ '% <br />~_ <br />Trans Colorado Concrete, ' of ~•~ = <br />Division of Pete Lien & Sons, Inc. °s i ;q?, a ~ ~~ ~ i <br />If Corporation AttesttSea~ ` ~'' ~ d . ~, <br />., <br />Applic ratoror panyName `e, `•• „...•''~~ <br />s; ~$ V t1 )v . <br />Signed: yl c Signed: <br />~'' Corporate Secretary or Equivalent <br />Title: ~~ ( -sue ~/i1~~~~1J/~~P~ Town/City/County Clerk <br />State of ~u~'h~q~;o~ <br />ss <br />County of e.t1o1!/1 a~J <br />The foregoing instrument was aclmowledged before me this nnI ~I3+f1- day of t~ bh t.lar 1 , Zp0 ~ , <br />by ~oel B(all(1(h/1 as~2J'IPX'Q~ l"lQIl00~Y of~r'anSColorad.o(nnCrete 4,~IU/S/Q>7 <br />of {fie LI~v.Sonsfs/1C, . <br />K~i~tv'~.~,.e~na~tc, <br />Notary Public , <br />p.:.:~~frA F. FERNAU <br />. ~ ,: `~".- ~.~''~ W11'.COTy1MISSION EXPIRES <br />My Commission's ~ues:'~ }'~~~~~ z5, 2007 <br />- o~~ <br />~•l° J ~ 1.1 r`.`~ `' <br />SIGNATURES MUST BE IN BLUE INK ! ~;,_ . .-;r <br />_ `A <br />M:U9P~BDC\MINPORMS~2823C012.APP 10/17/01 ~ ~~"' ~•~~~ <br />S.~ <br />iu:uP, <br />