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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 ofniy 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 applicantioperator, I do not have any extractionlexploration 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 Class 1 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 34-3Z, 5-112,C-R-5 , of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or mod cation of this form sholl result In voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and ciph! penalties for operating <br />without a permit pursuant to section 34-31.5423, C.R.S. <br />Signed and dated this day of 2009 <br />- <br />All-Rite Paving Redi-Mix, Inc. <br />Applicant(Operator or rnpany <br />Signed: <br />Title: __ ?° ????' <br />If Corporation Attest (Seal) <br />Signed: r <br />Corp rate Secretary or Equivalent <br />Town/Ciry/County Clerk <br />State of. Colorado _ <br />? g )88. <br />County of <br />The foregoing instrument was acknowledged before me this day of _..-__ _ '92U 0 Y _ <br />..._ 1..1.Q. - -.._...__ _ of ' f1 JU. <br />If __ .._.._.._._.__as <br />_..._, by -_._..__...-,rYL_..?.f'? <br />?latlit ? ? ? _ <br />;ai. <br />ST. ppE OF COt,ORA00; 4NolISlic <br />rnmission pins , <br />My Commission expires:._.. 02 --l---- -gip/ 19 <br />_ <br />SIGNATURES MUST BY IN BLUE INK