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S- <br />Certification' <br />As an authonzed representative of the applicant, l hereby certify that the operation described has met the rmnimum tequimnents <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 existrncc at the time <br />this application is filed, and located within 200 feet ofthe proposed affected area have barn tdrnbfied m this application <br />(Section 34-32.5-I I5(4)(e), C.R.S.). <br />2. No mining operation writ 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 applicanUoperator, I donor have any extractioNexplaration operations in the Staze of Colorado curmttly in <br />violation oC the provisions of the Colorado Laztd Reclamation Act for the F.ztraction of Construction Matenals <br />(Section 34-32.5-120, C.R.S.) as determined through a Board finding. <br />a. I understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein arc punishable as a Class 1 misdemeanor pursuant to Section IS-g-503, C.R.S. <br />Th8 form has bun approved by the Mined Land Rtt/amatlon Board punuwu Io section 31-32.5-fI2,C.R.S, ojrhe Co/orada Land <br />Reclamation Act jar the ErlracNoa ojConaMtctian Mapedafs Any akeroHow ar modiflcadan ojrh/s form shall nsuft in vowing aay <br />p<rmb issued on We altered ar modtJ7ed form and subfect the opcrotar ro Beare and desist orders and riv/! penaldrs jar operating <br />without o pe~mitpursu~nt to.reedon 3J-325-123, C.R.S <br />Signed and dated this ~L~. ___ day of ~~t EM~C~i 2006 <br />Lafarge West, Inc. If Corporation Attest (Seal) <br />ApplicanUOpe~tor o~ComNamc ` <br />Signed: 1~ ~Nl(T~ Signed <br />Corporate Secretary or Equivalent <br />Title: vQ.-OF e~O~ ~'N~E ~P~~~S <br />Town/CitylCatmty Clerk <br /> <br />State of CAL(~P.F~DO } <br />ss. <br />County of _~~~SO(~ _) <br />The fureggmg instrrm~en[ was acknowledged before me this _~~~~~daygof~,__~_~ }~~.~- ~ <br />2006., by-_i~~---~tlt.~.-.- -as~P-'~ Q, b ~/ItL 1~.-~'4+-4--of -- ~-e"'~`_'-t~- <br />~, .. ., • r,~s +~s <br />O ~ •,-$., tc Notary Public <br />~. ir% • Ss m ~ . ~~ <br />.^- ~ ', ~ f ' My Commission expires: ~ o""' t <br />- ~ - <br />~t r' j• SIGNATURES MUST BF. 1N BLUE INK <br />j •......•.•. ~j <br />(/ d .;m~,n c;uetrixnr~~~i~K~ro~re uvii.2ros) <br />N//rb Ilp Hlt\U ~ f.a„ Sr°1 <br />J f ...`.... :. ~•. <br />--. .. - .= S~~-~,I--s---- - -- -- <br />:,; •co~co~oo <br />LORP__ . <br />~~~;h. . <br />