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CER`l'1 MATION <br />TheApplicant, LQZu _ &ar- ..and CA- CCA - <br />_... , <br />E Print aPPHCan 0DMpany name). <br />by � {�t tativres name), as Manager {prim <br />reptesentatives. title), does hereby certify that E k eilttt L LC— (structure owner) shall <br />be compensated for any darnage from *a proposed mining operation to the above listed sruaure(s) <br />located on or within 200 feet of the proposed affeeW area described within Exhibit A, of the Reclamation <br />Permit Application for Uncompahgre Pit <br />(opecffiion name), <br />File Nmunber M- 2013,007, <br />T!* fom ISmts ftm Wpe ow d by Ike CdaradoAfrmalend Re akmation Bawd pmwm a to irs <br />oar A k raider the Cok ra& Lend Raclarnu&m Act for the F.aovedon of Count Materials and <br />the Colarwdo MUee Lead Red wm m Act for Hard Rao Meft& =dDmWxmWAf&ft QPa'a ono <br />Any alt utbn or nwd#7cadm to jAwformsk&y result in voidIng tkis farm <br />ACKNOWLEGED BY: <br />Applicant g k gt�t-" �L'PaTk- ` iG 1 P Rep <br />rescntarive Name <br />Date F-kA cam. ry 1.2- gn__ /_•S" ___-__ TIddc <br />STATE OF COL47RADO <br />COUNTY OF MoAn74561 <br />The foregoing was acknowkdged before me this 12 day of � 't'' .. 2015 by <br />CA�yt 4K t� p- Leta j CAJTL E_ CD! I J P <br />Commission Expires: 1 2U 1 to <br />sy <br />