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-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 34-32.5-1 15(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 b}y 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 a►t v <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 4th day of November, 2016 PNCOCOGy.A <br /> SEAL <br /> Rio Blanco County If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name NpRpCA <br /> Signed: Signed:�� � <br /> David P. Mo <br /> Corporate Secretary or Equivalent <br /> Title: Road & Bridge Director Town/Ci ounty Clerk~ <br /> State of Colorado <br /> )ss. <br /> County of Rio Blanco <br /> The forego in instrument was ackn wledged before me this 7 day of <br /> -, by � as A^A of <br /> -- <br /> FNOTARY <br /> ERI M. GILCHRIST <br /> CAL'129 a�X,1,,,Y <br /> NOTARY PUBLIC Nota ublic <br /> TATE OF COLORADO <br /> ID#20094011299 ��_ <br /> mmission Expires July 3,2017 My Commission expires:d� —�/, <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 />