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aCRTTIFI.CAHM <br />Tlw Applicant, Lan K 8 ar La t,A c - C!pL � 1 e- tp - applicanttcompany name). <br />(print mpreststtative` s mime), as M2111a9er (*t <br />rejuesentatiWs title] does hemby certify that , avteg I —k (sauctura owner) shall <br />be courgmmted for any damage from the proposed mining operation to the above listed structures) <br />located on or within 200 feet of the propoud affected area described within Exhibit A, of the R�eclarnation <br />Permit Application for Uncompahgre Pit (operation name), <br />File Number M-1213- -007, <br />Tyftis f wm has been approved by the Colorado Mined Land Rwlawwd m Board pammW to its <br />aut eo&y a rder the Colorado Land Radonsti n Act for dw Ezue iox of Com*Wdtonn M all <br />Aw CAkrado Aaw dLandltwhwm m Ad for Hard Rork M" and Da*maud Mixing' OperaiMM <br />Any adteradm or xwd#kWlox to this form shag result in Mid* ibis firm <br />NOTAM FOR PERMiT APPLIGAAi'i <br />ACKNOWL.EGED BY: <br />�- ��.�, &- Ran <br />AQplicant 1� ►�2E7 %2'1a tative Name i, .,S a-c <br />Date 6s b a"x _ tom _ 121.5- Title c�3•v�A._..7'. _,_ 2+. per �1� s <br />STATE OF CO LOCA-D O } <br />ss. <br />COUNTY OFD" (OMTOD <br />The foregoing was acknowledged before me this 12. day of 201 by <br />-as-RAWAI, l-Af 1 1Zsf Llaq K PAP, LAW 0 <br />DaMF-iw e+r i <br />cHEzE . <br />�� <br />Expires: <br />