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<br />Certifieadga: <br />-8- <br />As an authorized representative of the applicant, I hereby certi fy 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 e.4istence 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 ia"v <br />(Section 34-32.5-115(4)(t), C.R.S.; <br />3, As the applicantloperator, 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 3¢32.5-II2,C.&s., ofille Colorado Land <br />Reclamation Aetfor the Extraction of Construction Materialk Any alteration or wedijkadon ofihis form shag result in voldingany <br />permh issued on the altered or modZed form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-325-723, GR,. <br />Signed and dated this nd day of Lt l ' Z3 <br />Grand Junction Concrete Pipe Co. <br />Applicant/Operator or Company Name <br />If Corporation Attest (Seat) <br />Signed: ! <br />Title: ap-qfelp, <br />State of C 0k) R I <br />County of ss. <br />(Y) S >') ) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged beforeme this .?? day of _ ?Tc?Yt C.?- 260 <br />by as ?t of -?Q??c <br />r <br />My Commission expires: _ <br />wJ5 <br />SIGNATURES h BLUE INK <br />1002