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09/29/2007 SAT 9:38 FAX 720 977 6291 CITY OF THORNTON-INFRA U010/010 <br />Certification: <br />-8- <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />1 _ To the best ofmy 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 />1 No mining operation will be located on lands where such operations are prohibited by law <br />(Section 3432.5-115(4)(f), C.R.S.; <br />3. As tlhe applicantloperator, I do not have any extractionlexploratian 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 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />This form has been approved by the Mined Land Reclamadoh Board pursuant to section 34-32.S-112,C.+R.S., of lie Colorado Land <br />Reclamation,Ict for the Extraction of Construction Materials. Any alteration or modifteadon of thisform shall result in volding any <br />Permit issued an the aliened or modified form. and subject ehe operator to ceases and desist orders and civil penalties for operating <br />without a permit pursuant to section 5¢325-123, C R.S. <br />r? <br />Signed and dated this , day of to Z d? <br />Applicant/Operator or Company Name <br />r <br />Signed:// <br />Title: _-? _ l llt <br />y/ If Corporation Attest (Seal) <br />Signed_ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of r e r <br />ss. <br />County of Me r 4.a r <br />The foregoing inst ment was acknowledged before me thi day ofd J G = Irt <br />2045 by ? l,r n C. (? as f?S i prl f of 43c??y?e <br />4t,?i,, rr ,?rrl»,yfl? r, <br />a '61 <br />a ublic <br />fly Contriwon E*ms <br />? r? My Commission expires: 06123PW <br />• : AEA, °{, ; f' i g :? <br />SIti'I?Ml?K?71 - bE IN BLUE INK <br />U;01inwhmw1vsrormdCQW1UCd6n 112.doc (Approved 05111/2005] 9r