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.. `N i <br />-8' <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of <br />the following terms and conditions: <br />1. To the best of my knowledge, all sigIIificant, valuable and permanent man-made struc4ue(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed afi'ected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <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.RS.; <br />3. As the applicandoperator, I do ttot have airy 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.RS.) as determined through a Boazd finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class Z misdemeanor pursuant to Section 18-8-503, C.RS. <br />Tkis form kas been approved by the Mmed Land Reclamation Board pursuant to section 34-32.5-11$CRS, of the Colorado Land <br />Reclamation Ad for ffie Exbadion ojConstrucNon Materials. Any alteration or modifuation ojthisjorm shaUresutt in voiding any <br />permit issued on the altered or modg4edjorm and subject the operator to cease and desistorders and civilpenal8esjor operatbtgxdhout <br />a permit pursuant to section 34-32.5-123, CRS <br />Signed and datedthis 9th day of September Zoos <br />Oldcastle SW Group, Inc. dba <br />United Companies of Mesa County <br />Applicatrt/Operator or Cornparry Name <br />Signed: <br />Title: U/ce p/'PSrCIlUt7- <br />State of ~o (~ r~r~D <br />ss. <br />County of <br />The foregoing ine+n,rrrrnt was acl~towledged <br />by ~i'R;q' /~otA'1~Gr'f~-as <br />c <br />if CoipOIatIOII Attest (Seal) .. ,~ <br />~i _~ <br />Sign (~"" ~ +l~ <br />Corporate S or Equivalent <br />Town/City/County Clerk <br />G <br />t° r ~, <br />of old ~cr-s t a 5u~~~s~P, I/w~ ~~ <br />~ p Cokry'/ <br />~tej otCvrJist9-L~ ~L1 , >~ ~ o~-~ ,,. <br />ary Public <br />Commission expires: ~~~ ~ <br />SIGNATURES MUST BE IN BLUE INK <br />~~~~~~~son tu.a« tnvp~ored osittnoosZ <br />