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CERTIFICATION <br />The Applicant, HUERFANO COUNTY GOVERNMENT (print applicant/company name), by <br />E. Ray Garcia (print representative's name), as Chairman <br />(print representative's title), does hereby certify that Oxy USA, Inc. <br />LLC. (structure owner) shall be compensated for any damage from the proposed mining operation to the <br />above listed structure(s) located on or within 200 feet of the proposed affected area described within <br />Exhibit A, of the Reclamation Permit Application for LONE TREE GRAVEL PIT (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 <br />and the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining <br />Operations. <br />Any alteration or modification to this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEDGED BY: <br />Applicant HUERFANO COUNTY GOVERNMENT <br />Representative Name E. Ray Garcia <br />Signed: Date 2/24/15 Title Chairman <br />Representative Name Max Vezzani <br />Signed: Date <br />Representative Name d Cisneros <br />Signed: _. Date <br />STATE OF Colorado ) <br />~) ss. <br />COUNTY OFHuerfano ) <br />2/24/15 Title Commissioner <br />2/24/15 Title COMP�,% h?pej� ;r <br />c.. <br />The foregoing was acknowledged before me this-)f day of , 20 by ; <br />Notary Public My Commission Expires: <br />DENISE R VIGIL <br />NOTARY PUBLIC <br />STATE Of COLORADO <br />NOTARY 10 19954014699 <br />MY COMMISSION EXPIRES SEFTEMMfl :29,20]15 <br />