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Certification: <br />Signed and dated this 4 day of April <br />Dietzler Construction Corporation <br />Applicant/Operator or Company Name <br />Signed: <br />Title: President <br />State of Illinois <br />County of Cook <br />) ss. <br />- 8 - <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, 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 Lund <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, C.R.S. <br />2012 b Daniel P. Dietzler a President <br />• <br />• "OFFICIAL SEAL" • <br />JANICE A. HICKEY 2 • <br />: Notary Public, State of Illinois <br />• My Commission Expires 03/16/20162 <br />SIGNATURES MUST BE IN BLUE INK <br />, 2012 <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City /County Clerk <br />The foregoing instrument was acknowledged before me this 4 day of April <br />of Dietzler Construction Corp. <br />itA . t n • t Q LJ(L <br />No Public <br />My Commission expires: 03/16/2015 <br />You must post sufficient Notices at the location of the proposed mine site to clearly identify the site as the location of a <br />