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-~- <br />CerCdcatiou: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary approvals from local govetmnen[ have been applied for (Section 34-32.5-110(1)(s)(VIII). <br />2. 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 feet of the proposed affected area have been identified inthis application (Section 34-32.5- <br />1 I5(4)(e), C.RSJ. (NOTE: For 110 operations, the affected area includes all lands delineated by the permit boundary.) <br />No mining operation will be located on lands where such operations are prohibited bylaw (Section 34-32.5-1 IS(4xf), C.RS.). <br />4. As the applicant/operator, I donor have any mining/exploration operations in the State of Colorado currently in violationofthe <br />provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R. S.). <br />5. I understand that statements in the application are being made under penalty ofperjury and that false statements madeherein are <br />punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />Thisform bas been approved by theMmed Laid Reclamation Board pursuant to section 34-31.S-Il0,GRS, ojthe tolorado Land <br />RechrmationAdjor the Extrae~ion ofConstrudion Materials. Any alteration or modification ojthisjorm shall result in voiding any <br />permit issued on the altered or modifud form and subject the operator w cease and desist orders and civil penalties jor operating <br />without a pennitpursuant to section 34-31.113, C.RS. <br />Signed and dated this --f-day of r~/r TL,~~ r ~ZOD,S' . >< <br />P.i~C`12zlsr .Ped~ _111r,~~cr~~c,`nC <br />Ap IicanUOperator <br />If Corporation Attest (Seal) <br />Signed~~,~ I~c/~-ems ?~ <br />,- <br />Title: t~Ctl /7 ~ <br />Town/City/County Clerk <br />State of Colorado ) <br />ss. <br />County of Phi ~ ~ i ps 1 <br />The foregoing instrument was acknowledged before me this / 9 ~ day of t"//~ :2~? a s <br />by_iPrr~ uirrhay as Owner/Operator of Ritchevs' Re3i=Mix-Concre.t~~, Inc. <br />Notary <br />Signed:'~//s~//f r X <br />Corporate Secretary or Equiva~~ <br />My Commission expires: <br />SIGNATURES MIIST BE IN BLIIE INK <br />M:~mia~aearetvsfrnma~eonsl,actiont to tapprovee osn trzoos) <br />