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E0 F I V <br />1 0 2013 - 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) inexistence 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(4xf), 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 detennined through a Board finding. <br />4. 1 understand that statements in the application are being made under penalty of periury 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 thisform 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 />Signed and dated this 17« day of MARCH 2013 <br />McStone Aggregates, LLC If Corporation Attest (Seal) <br />Applicant/Operator or Co pany Name <br />Signed: Signed: <br />Corporate Secretary or Equivalent <br />Title: Manager Town/City /County Clerk <br />State of South Dakota ) <br />) ss. <br />County of Pennington ) <br />The foregoing instrument was acknowledged before me this _ 171h day of March. 2013 , <br />by Casey McClellan as Manager of McStone Aggregate LL <br />•! <br />NATHAN A BARTON Nathan A. Barton <br />• C�J • Notary ublic <br />NOTARY PUBLIC ry <br />o� STATE OF SOUTH DAKOTA <br />My Commission expires: 12 DEC 2014 <br />SIGNATURES MUST BE IN BLUE iNK <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 />