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CERTIFICATION <br />The Applicant, Phillips County, by Harlan Stern, as Chairman of the Board of County <br />Commissioners, does hereby certify that Haynes Hereford Ranch, Inc., owner of the fence which <br />encompasses the Haynes Hereford Ranch Gravel Pit and the water spigot lying in the southwest <br />corner of the permitted area, shall be compensated for any damage from the proposed mining <br />operation to the above listed structure(s) located on or within 200 feet of the proposed affected area <br />described within Exhibit A, of the Reclamation Permit Application for Haynes Hereford Pit, File <br />Number M- 2004 -023. <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 <br />and the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining <br />Operations. Any alteration or modification to this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEDGED BY: <br />Applicant — Phillips County <br />Repres tative Name- H rlan Stern <br />Date '1 p— f <br />Title Chairman, Board of County Commissioners <br />STATE OF <br />COUNTY OF <br />The foregoing was acknowledged before me this day of b , 20/ ' by <br />3 <br />04 40 6 0 P►'� as �� ��i �e�nrrr /s5 /en�i' of � A h117 _. <br />RANDALL D. SCHAFER <br />My Commission Expires: /Z zp,- 11b NOTARY PUBLIC <br />STATE OF COLORADO <br />Notary Public NOTARY ID 19954016062 <br />MY COMMISSION EXPIRES 12/06/2016 <br />