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CERTIFICATION <br />The Applicant, Western Slope Aggregates, Inc., by Sean Mello, as General Manager, does <br />hereby certify that L &l.e-sW E/VZL !_(structure owner) shall be <br />compensated for any damage from the proposed mining operation to the above listed <br />structure(s) located on or within 200 feet of the proposed affected area described within <br />Exhibit A, of the Reclamation Permit Application for Blue Pit, File Number M- 1981 -207. <br />This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br />under the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado <br />Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. Any alteration or <br />modification to this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant CJ.,t presentative Name <br />Date �` f s t- i `� Title <br />STATE OF a ) <br />�� ) ss. <br />COUNTY OF f/' ) <br />The foregoing was acknowledged before me this /a Iay of Tivl-7' , 20%, by <br />o�My Commission Expires: o°Z D / <br />PEGGY E. RpPis' <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY {D #19964018779 <br />My Commission Expires November 5, 2016 <br />