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<br />-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met 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) inexistence at the time <br />this application is Fled, a.nd located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S.). <br />2. ~~lo mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)0, C.R.S.; <br />3. As the applicantloperator, I donot have any extractioniexploration operations in th.e 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 are being made under penalty of perjury and that 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 alined Land Reciamation Board pursuant to section 3d-32.5-112,0 RS., of the Colorado Land <br />Reclamation tact jor the Extraction of Construction ,'-'llaterials. Any alteration or modification of this form shall result in voiding any <br />permit issued an the altered or modified farm and sub,~ect the operator to cease and desist orders and civil penalties for operating <br />without a permitprrrsuant to section 34-32.5-123, C.R.S. <br />Signed and dated this 5th day of March <br />Halde Sand & Gravel, Inc. <br />ApplicantJOperator or Company Name <br />Signed: '~ <br />K" r Halde <br />Title: President <br />2008 - <br />6 - G <br />- <br />V <br />of Corporation Attest (Seal} ~.,(~ "- ~` ~ _ _ <br />.: ,~ ,. <br />Signed: Cs~ <br />Corporate S retary or Equivalent <br />TownlCity/County Clerk <br />State of_ Colorado ______ __ __ ___ ) <br />} ss. <br />`1`he foregoing instrument was ackno~,tlcd~ed be:fi:~re me this _.___..5th-_.-_-_ day of .-.._:_-_ March <br />2.0__0 ley _.._.- ,Kerry---Ha l de------------~---------------------------''s ..---- -President <br />"-' ""' _ _ of._-_Halde--__Sand-__&--_ Grave_1_l.Inc . <br />Notary Pu~ic <br />ivly Ccmn,ission ~~ires <br />?1rly Commission expires: ________ 07/21/2010 <br />S[(xNATC~It.RS 1~l,LS,I: I~:~~ I.11 l3I~C`lN; IltilK <br />