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-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) in existence at the time <br />this application is filed, and 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. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, 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 <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 I misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-112,C.R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this farm shall result in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties, for--operating <br />without a permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this /F day of d EC_ EMS <br />ASPHALT CONSTRUCTORS, INC If Corporation Attest- S al} -, x <br />Applicant/Operator or Company Name; <br />Signed: Signed: <br />TODD A. STOCKEBRAND <br />Corporate Secretary or Equivalent <br />Title: PRESIDENT <br />Town/City/County Clerk <br />State of COLORADO <br />--- ------------------ - ----) <br />County of ___ ALAMOSA }ss. <br />The foregoing instrument was acknowledged before me this 40 V4N day of <br />T by -TODD A. STOCKEBRAND as PRESIDENT a (ASPHALT CONSTRUCTORS, INC. <br />- 1y}•? 0 i ?_ F ?? i <br />Notary Public_ <br />M 13 -2011 <br />' Cammissian expires: ,_ W,_, <br />y _ _ <br />t~ <br />SIGNATURES 1tL IP?.I I,131 [t '?tiK