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CI:RTIFICA'110N <br />The Applicant. HUERFANO COUNTY GOVERNIMMI' (print applicaltt /company name), by <br />_ (print representative's name). as <br />(print representative's title), does hereby certify that the SAN ISABI 1. ELECTRIC ASSOCIATION <br />(structure owner) shall be compensated liar any damage from the proposed minim, operation to the above <br />listed structure(s) located on or within 300 feet of the proposed allected area described within Exhibit A. of <br />the Reclamation Permit Application for PEAK VIEW GRAVEL. PIT (operation name). <br />This farm huts been approved htr the Colurn(lo Miner) Land Reclanuttiau Boarrl pursuant to its <br />authoritl- miler they Colorado Land Reclrunation Act jar the Extructiott of Cmtstructiutt Moteriulc <br />tuul the Colorado Mined Lune! Rec lutuation Act for Haul Rock, Metal, and Designated Mitting <br />Operations. Attp alteration or ntad ftcatiott to this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWL.EDGfiD BY: <br />Applicant HUERFANO COUNTY GOVERNMENT <br />Representative Name Art S. Bobian <br />Si�:ncd:��,77` -fir •-- Date 7/30114 Title Chairman <br />�J <br />Representative Nance-Max Vezzani <br />Signed: ;Xr�< --.- Date 7/30/14 l itic Commissioner <br />Representative Namc Edward R. Garcia <br />Si�_ncd: !iL / Date 7/30/14 Title Commissioner <br />STATE OF <br />COUNTY OI' <br />1 <br />) S5. <br />) <br />The foregoing was acknowledged before me this l daN' of 20d by <br />o — Iluer#-ano -Gea toners <br />Notary Publ c II% Commission Expires: � <br />[My COMIISSIONEXPIREg9 1�(�� jj� 2faRAITRUCTURE OWNER <br />ACKNOWLEDGED BY: <br />Structurc Owner SAN ISABHL I LEC'TRIC ASSOCIATION o <br />Representative NantcjjfJQY ,a/�Y19�' ;rv61 <br />'`,� COO �. <br />Signed: ,�_ O\, <br />Date 41- - y title 1AA -1A-c1c �.lF Ot�G%h( DF -�udy <br />STATE OF0 -darn„ -fir, ) <br />) S1. <br />COUNTY OF <br />The foregoing was acknowledged bel'Ore me this: ?,�1 dad of . ?01 `f . by <br />ilti f�:r „_,��;� � 1.'r�.lJ(.iit.t �,llf f{r- _:1.,n I <br />Notary Publics �a[:,,_ 'f ; .�.:_ i ...:: My Commission Expires: ;�I_ a�.�� %! •.� <br />