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CERTIFICATION <br />The Applicant, Western Slope Aggregates, Inc., by Sean Mello, as General Manager, does <br />hereby certify that 3 p_9 `L A'-wrt r> (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 />� 5 ,aL <br />Applicant (� ),, s't'y..> <,z.Pz 4 epresentative Name <br />Date Title <br />STATE OF ) <br />ss. <br />COUNTY OF ) <br />The foregoing was acknowledged before me this /.2-4ay of 20ZZ, by <br />���/!d"l -f /� as���rG /.�i�i'C.�2g�'�si/of Gif/.�s7�'�''/� .��,o -a' �� • -h�Z`; <br />_ l My Commission Expires: <br />Nota is <br />PEGGY E. F IPPY <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID #19964018779 <br />My Commission Expires November 5, 2016 <br />