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<br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terrors and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 fcet of the proposed affected area have been identified in this application <br />(Section 34-32.5-L 15(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 3432.5-115(4xf), <br />C.RS.; <br />3. As the applicant/operator, I do not 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 Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board Ending. <br />4. I understand that statements in the application are being made under penalty of perjury and thaz false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this / s r day of /L//~fs'~ // , .:2/^F7 / <br />kggregate Industries West Central Region, Inc. <br />Anplicant/Operator or Company Name <br />Signed: ,~ ~l J'l7lrt yr. SS (%-G2~/ <br />If Corporation Attest (Seal) <br />_..-, <br />7 ~ ~ ~~ <br />Signed: ~r-~' <br />hss ~ Corporate Secretary or Equivalent <br />Title: Mi/~~i/it4-,~i~- TownJCitylCountyClerk <br />State of ` 4-e9~-a O~t-~ 1 <br />County of ~~,fS~ ~ ss <br />v <br />The forego~''~g instrument w aclmowledged befor~epme this ~~-ST day of ~' ~~ ~Cc ~ <br />by %L~`"Yii7 ¢ n ~d C%~.~ as /Z ~Qr/~- - - - of ~~ltQ~it~ ~- lfJ~ ~a.' .2°r..( <br />aV U ~~.r~,,, o9.c <br />~?aY PUS 1~~~-~-~~~_ <br />o ~ ••~~ <br />r• BAHBAiIA S. ••'~ Notary Public <br />SUDERMAMM <br />~.•'•, .~ ~ My Commission expves: `~~4 ~c~'L~o 7 <br />SIGNATURES MUST BE IN BLUE INK <br />