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<br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the nrirrimtun requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, all signiScant, valuable arrd permanent man-made sWcture(s) in existence at the time this <br />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.RSJ. <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), <br />C.RS.; <br />3. As the applicanUoperator, 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 tivough a Boazd Ending. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this _~ day of - 2, ~ ~ l <br />ApplicanUOperator or Compan e <br />Signed; ~~ <br />Title: ~ ~~( <br />State of Colorado <br />County of Adams <br />ss <br />If Corporation Attest {Seal) <br />Signed: i • (~.+~. --. <br />_ . _ _ ~. <br />Corporate Secret?ry-fir Egaivalent. "~ ~ . <br />Town/City/Co ity ~lc-i~k •' _ ', <br />The foregoing instrument was aclmowledged before me this 3rd day of May , 2 0 01 <br />by Mike E. Owens as President of Owens Bros Concrete CO <br />John L. Owens Corp. Secretary Owens Bros Concrete CO <br />~~(,_~ <br />d E~TTY H. GIWS NotaryPublicBet~ y 'H. Gillis <br />NOTARY PUBLIC <br />}} ° PPTE OF COLOfiADO My Commission expires: <br />L.,~ <br />My Commisalon E~ItM td~7/100/ <br />SIGNATURES MUST BE IN BLUE INK <br />