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CERTIFICATION <br />The Applicant, Crossfire Aggregate Services, LLC <br />(print applicant/company name ), <br />by Jay Nielson (print representative's name), as General Manager (print <br />representative's title), does hereby certify that Red Cedar Gathering Company (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 Bends Gravel Pit <br />File Number M-- _(TBL)_. <br />(operation name), <br />This form has been approved by the Colorado Wined Land Reelam adon Roard pursuant to its <br />authority under the Colorado Land Reclaxwfton Act for the Extraction of Construction Materials and <br />the Colorado Muted Land Redanwhon Ad for Hard Rock, Metal and Designated Mining Operations. <br />Any alteration or n+vdi; cation to this form shall result in voiding this form <br />NOTARY FOR PFItMff APPLICA_ -NT <br />ACKNO%LEGED BY: <br />Applicant ro S i e 1 c e msentative Name �'e � 5c,✓� <br />Date `[ - Q'4-d ®I S Title <br />STATE OE ,Ctc ;> � (At� } <br />COUNTY OFJ_6 <br />The foregoing was acknowledged b�fore me this e'-`f day of )Z y lr'i , 20 �,. by <br />V C +! as ��-6it RAP �G �Z Y'Z+'l; to l L <br />+J Ij <br />o-� My Commission Expires: % C /��(� �r <br />Notary L'ubli <br />read N" 8R}'SO <br />l'10TARy <br />�; PUBLIC_�� <br />