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CERTIFICATION <br />The Applicant, Yuma County Road and Bridge _(print applicant/company name), <br />by Howard McGinnis (print representative's name), as Truck and Mining Foreman (print <br />representative's title), does hereby certify that Caleb and Kari Schultz structure owner) shall <br />be compensated for any damage from the proposed mining operation to the above listed structure(s) <br />located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br />Permit Application for Moser Pit <br />File Number M- 2008 -035 <br />(operation name), <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 and <br />the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. <br />Any alteration or modification to this form shall result in voiding this farm, <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant �411;m OzuA,71 <br />If --------- . .... - ------ - - U&C/ -1 el? Representative Name <br />Date /7— ee)S— Title 1 1?d rK 4 <br />STATE OF <br />COUNTY OF qk,—q <br />The foregoing was acknowledged before me this day 20t '-), by <br />_VV0 1aav"_t foregoing I <br />N <br />My Commission Expires <br />—t ��� <br />�No­uk- <br />l' 3 -aO to <br />Yq <br />NI <br />.M <br />MRIvs "'m <br />