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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. 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, CXS. <br />This form has been approved by the Mined Land Reclamation Boardpursuant to section 34-32.5-112,C IL&, of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials Any alteration or modification of this form shag result in voiding any <br />permit issued on the altered or Ana fted form and subject the operator to cease and desist orders and civil penalWm for operating <br />without a permit pursuant to section 34-32.S-123, CRS <br />Signed and dated this day of Mardi 2011 ,y r h $r <br />Stone Sand & Gravel, LLC <br />Applicant/Operator or Company Name <br />r <br />Signed: <br />Kathy St ne <br />Title: Manager <br />State of Colorado <br />?J l <br />If Corporation Attest <br />Corporate Secretary o q*2 <br />Town/City/County Clerk <br />) ss. <br />County of M-t- <br />The foregoing instrument was acknowledged before me this day of March 2011 <br />by Kathy Stone as Manager of Stone Sand & Gravel, LLC <br />••• ,•?`? ' <br />J{' <br />r WA <br />Notary Public <br />My Commission expires: <br />?G • o <br />••' , j??a' SIGNATURES MUST BE IN BLUE INK <br />1r? OF <br />You must 00sfi suf$cient Notices at the location of the proposed mine site to clearly identify the site as the location of a