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<br />-8- <br />Certification: <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 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. 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 34-32.5-112,C.R.S, of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials Any alteration or modification of this form 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, CR.S. <br />Signed and dated this day of PA_OJ ?N , R61 ? <br />Grand Junction Pipe & Supply Co. <br />Applicant/Operator or Company Name <br />Signed: dla`/ Q <br />401'r - <br />Title: Marie Tipping, President <br />State of Colorado <br />ss. <br />County of Mesa <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this `144- day of lM G? X V? <br />0 by (l.X L ri (?? !1 as Vft S iCkA_ ofhy'a Y1 1 nI _-Eior' C if) C( k <br />u. <br />I A I'A4 A I I 'L Z" <br />Y?;At ?;'.ly? Notary Public. <br />a My Commission expires: 3 a <br />SIGNAT MUST BE IN BLUE INK <br />You must post sufficient Notices ,qt? %Qawd he proposed mine site to clearly identify the site as the location of a <br />If Corporation Attest (Seal) <br />Signed: 6, am &-'e <br />Corporate Secretary or Equivalent