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Certification: <br />Grand junction Concrete Pipe Co. <br />Applicant/Operator or Company Name <br />Signed: <br />Title: IC <br />1- <br />state of ._CIN OP, f■IX) <br />) ss, <br />Count fi 1) <br />- 8 - <br />As an authorized representative ofthe 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 of my knowledge, all significant, valuable and permanent man-made stnicture(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 34-32.5-1 15(4)(l), C.R.S.: <br />3. As the applicant/operator, 1 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 34-32.5-112,CR.S., of the Colorado Land <br />Reclamation Act for the E.viraction 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 orderx and civil penalties for operating <br />without a permit pursuant to section 34-32.5-123, CR.S. <br />Signed and dated this (14 day of <br />FILUI: INK <br />1611/2012 <br />If Corporation Attest (Seal) <br />ack - <br />The tbregoing instrument was acknowledged before me this day c. <br />of , <br />Signed: _ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />by htf— pf LITT _ as STe-, c con <br />- Notary Public <br />My Commission expires: <br />io/opoi,2_ <br />C Cd <br />