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The Applicant, LQZ4 _ K i3ar ai1A d- �.a-� @. CoW Print appiic anticompany name), <br />T <br />by - .- a _(print dative's name), as Manager (print <br />esatwYve title), doesheretry certify that ^,.acs J� LLC, (smzwre, owner) shalt <br />be compensated for any damage from the proposed mining operation to ft above listed saucan-e(s) <br />located on or within 2W feet of the proposed affected area described, within ,Exhibit A, of the Reclamation <br />permit Application for Uncompahgre Pit (operation name), <br />Fite Number M 293 --007 <br />2•ltls, fort An been apptnveed by she C.olomdo M ed Land AmAvoodon Boerd prusuant to itt <br />aWho & under Ike Cobnwb lard Rerlarramfion Act for the Extraedm of Conouedon Meta" and <br />Ike CoWndo Mrr ed Land Reeiwnafton Act for hard Rock, Metals and Degpated Mang Ope Mns. <br />Any artmsdon or xxWV kadan to tkts form shaft resu t in vvh tng this forat <br />t _ t <br />ACKNOWLEGED BY: <br />APPlicant 4 L.A'(1t� �aYt� ('� I/rRepresentative Name <br />Date t.cG.ry (;2 a .L.r? Title i�.L �e.- r� t r <br />STATE OF COL MA DO ) <br />sr- <br />COUNTY OF 1"E�1�1 fI:D <br />was acknowledged before me this 12 day of YfXWJAAf -9 2,0� by <br />T�s.l as (- mil amt . F!W5 -,Xk—of LALM K PaAfLCAkN Dt CATR-k -, C40 ! t tP <br />Commission Expires t f 412-01 fG <br />