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CERTIFICATION <br /> The Applicant, Greg Norwick, Everist Materials, LLC (print applicant/company name), <br /> by Greg Norwiek (print representative's name),as President (print <br /> Tri-State Generatwn 8 Transrrnssion Association,Inc <br /> representative's title),does hereby certify that (structure owner) shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br /> Permit Application for Morrow/Murphy Pit (operation name), <br /> File Number M-1979-187 . <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock,Metal, and Designated Mining Operations. <br /> Any alteration or modification to thfs,lorm shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLLEGED BY: ,,�i <br /> Applicant L 1���� M�CP—tA tLLf Representative Name �Q !VC/P,yj1GK <br /> Date to 123 jig Title_ hze S r�T <br /> STATE OF L01.rjr(AA0 ) <br /> ) ss. <br /> COUNTY OF �1[4lft1 — ) <br /> The foregoing was acknowledged before me thisr�day of 2011.4 ,by <br /> 1!q as2� <br /> My Commission Expires:_ L:� <br /> Notary Public <br /> ERIN McNALLAN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO RECEIVED <br /> NOTARY ID 20124054708 <br /> My Commission Expires Aug, 22, 2016 <br /> JUL 0 8 2014 <br /> Division of Reclamation, <br /> Mining&Safety <br />