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-8- <br />Certification: <br />As an authorized representative oft he applicant, i hereby eertify 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 structurc(s) in existence at the time <br />this application is tiled, and located within 200 Ii ct of the proposed affected area have been identified in this application <br />(Section 34-32.5-1 15(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)(1). 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. 1 understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a ('lass 1 misdemeanor pursuant to Section 18-8-503, (-.R.S. <br />This form has been approved hr the ,flitted Land Reclamation Board pursuant to section 34-32.5-112,0 R.,S., of the Colorado Land <br />Reclamation :4ct for the li.t-traction of Constrnctiott ,Materials. An ' ), alteration or modification of this form %hall result in voidinr;, at{v <br />permit issued oil the altered or modired 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 />(Id <br />Signori and dated this _? - day of (1 Z-) <br />Grand Junction Concrete Pipe Co. <br />Applicant'Operator or Company Name <br />Signed: _ <br />Fide: <br />is. <br />County of (Y??? f ? -- ) <br />1'lle foregoing instrumentt was acknowledged before me this J (IA <br />by t.'3i1?. --- as <br />?7 r1??.(1 <br />If(---'orporation Aucst (Scal) <br />Signed: -? ; )1/1 <br />Corporate Seeretarv or Equivalent <br />Town 'City County Clerk <br />day of <br />of L,?c 1?c1, ?Qn4 <br />Div Commission expires: IC)/(,) 1 Z(- %/ z <br />INh <br />cCte