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CERTIFICATION <br />The Applicant, Loveland Ready Mix Concrete, Inc., by Brad Fancher, plant operator, does hereby certify <br />that the City of Loveland Sanitary Sewer Main shall be compensated for any damage from the proposed <br />mining operation to the above listed structure located on or within 200 feet of the proposed affected area <br />described within Exhibit A, of the Reclamation Permit Application for Larimer Pit #21, File Number M- <br />1974-069. <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 form. <br />F.11 <br />A <br />E <br />NOTARY FOR PERMIT APPLICANT <br />STATE OF l0Iv ) <br />SS. <br />COUNTY OF n-,YA ) <br />Representative Name 1i1 <br />Title V ICA! PK&,an <br />W <br />The foregoing was a knowledged before me this day of , 20 1 , by60 -OD IANC }G(Z as V > LQ. 7cy StCUa of' , Coml \ <br />NO li 6 My Commission Expires:_ <br />Notaa Public <br />JOAN E. HORST <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />10 19944018957MYCOMMISSIONNOTARYEXPIRESSNOVEMBER21, 2016