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CERTIFICATION <br />The Applicant, Western Slope Aggregates, Inc., by Sean Mello, as General Manager, does <br />hereby certify that C-tpr< -b 0 0iz .,Ul (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 (a,L s vs � GUS � �v <br />Date G c'z (i `T Title c a�.� �►t- yr -�a�� s^- <br />STATE OF v ) <br />ss. <br />COUNTY <br />The foregoing was acknowledged before me thisjQ�ay of r t"W .G , 20�, by <br />My Commission Expires: <br />otary P ^ lic <br />�aF'EGGY C. RIPt- Y <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID #19964018779 <br />My Commission Expires November 5, 2016 <br />0 <br />