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Board of County Commissioners <br />AFFIDAVIT CERTIFICATION OF INERT STRUCTURAL FILL <br />May 13, 2015 <br />Libby Szabo <br />District No. 1 <br />Casey Tighe <br />District No. 2 <br />Donald Rosier <br />District No. 3 <br />TO: Colorado Division of Reclamation, Mining, and. Safety RECEnw ED <br />MINE NAME: Pine Junction Pit JUN u 2 2015 <br />MINE ID NUMBER: M-1977-245 DIVISION OF RECLAMATION <br />MINING AND SAFETY <br />OWNER: Jefferson County — Road and Bridge <br />Pursuant to Colorado Division of Reclamation, Mining, and Safety Construction Material Rule <br />1.1(20), the below listed materials are the composition of the inert structural fill that Jefferson <br />County is using to backfill slopes, build berms and maintain the road network within Pine <br />Junction Pit. <br />The composition of the inert structural fill (ditching material) is <br />Class 6 Recycled Asphalt 60% <br />Squeegee 10% <br />Decomposed Granite 20% AF & Report <br />Organic Natural Soils 10% / <br />V No Violations <br />Issued By: , <br />Michael W. Dobbs Project Manager <br />Jefferson County — Road and Bridge <br />21401 Golden Gate Canyon Rd <br />Golden, CO 80403 <br />303-271-5233 Direct <br />303-271-5222 Fax <br />mdobbs@jeffco.us <br />The foregoing letter was acknowledged <br />before me this 27th day of May 2015 by <br />Michael W Dobbs as Project Manager — <br />Road and Bridge of the County of Jefferso <br />State of Colorado. <br />Not���2�� tCLd4A, <br />fi€ial'Signatu e <br />VtA /t n <br />Commission Expiration <br />CQ v� <br />MARILYN J HOLYCROSS <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />Notary ID 20014000305 <br />Road and Bridge Division <br />�1y Commission Expires 01/04/2017 <br />21401 Golden Gate Canyon Road, Golden, Colorado 80403 <br />Phone (303) 271-5200 • Fax (303) 271-5222 <br />http://'effco.us <br />