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<br />-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has me[ the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, 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 azea 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 34-32.5-115(4)(f), C.R.S.; <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 <br />(Section 34-32.5-120, C.R.S.) as determined through a Board finding. <br />4. I understand that statements in the application aze being made under penalty of perjury and [hat 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 Miaed Land Reclamation Board pursuant to section 34-32.5-II2,C.RS., ojthe Colorado Land <br />Reclamation Act jor the Extraction of Construction Materials. Any alteration or modification of this jorm shall result in voiding any <br />permi! issued on the altered or modified jorm and subject the operator to cease and desist orders and civil pens/ties jar operating <br />without a permit pursuant fa section 34-325-123, C.RS <br />Signed and dated this ~ day of c~ti /!,t' . ~L~i` ~ <br />Glenn E. Sessions & Sons, Inc. <br />If Corporation Attest (Seal) <br />ApplicandOperator or Company Name <br />Signed: //o-c_ ~~ <br />Title: Vice President <br />Signed: I <br />Corporate Secretary or Equivalent ' <br />Tovvn/City/County Clerk <br />State of X ~ ~~ ) <br />ss. <br />County of ) <br />The foregoing instrument was acknowledged before me this ~ day of . <br />d~, by s'T1J E SES,S/Q,uS as vie F P~~si ftlT of (,.LF_ilu F_ ,4ESS/D.4/S <br />SOAJ9~ Z'AJG~. <br />~`~Y ° ~'' <br />~LUGEA } otaryPublic <br />~~ ~ My Commission expires: <br />~~ rt7~.~ <br />My Commission Ezpires~lQ~~.uRES MUST BE IN BLUE INK <br />..n_..n.r,...~.,.r .m~rr,.,.amr.Gnn i n nnc lAnnroved OS/1 I/20051 <br />