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Affidavit for Import of Materials into JRS Mine <br />Date or Time Period of Import: <br />Description of Import Material: <br />Entity Providing Material to Pit (not the trucking Company): <br />I hereby certify that the material described above and brought to the Sullivan Aggregate Pit site is inert, <br />which means it is free from any chemicals, toxic substances, acid forming material, or any other material <br />which would violate the material waste disposal laws of the State of Colorado. <br />Signature <br />Written Name of Signer <br />Signer's Position in Company Company Bringing in Material <br />Date: <br />I hereby certify that the material described above and brought to the Sullivan Aggregate Pit site is inert, <br />which means it is free from any chemicals, toxic substances, acid forming material, or any other material <br />which would violate the material waste disposal laws of the State of Colorado. <br />Signature Written Name of Signer <br />Signer's Position as Responsible Party for Permittee Company <br />Date: <br />Sullivan Aggregate Pit March 2015 D -7 <br />