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CERTIFICATION <br /> The Applicant, Arnolds Custom Seeding LLC (print applicant/company name), <br /> by Rick Gillan (print representative's name), as Vice President (print <br /> representative's title), does hereby certify that Weld County (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 Arnold Pit No. 1 (operation name), <br /> File Number M- 2016 02? <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 /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOW/L�E..GED BY:: / Rt <br /> Applicant /-K Y\00S �,S. v�, in g Representative Name Cg �OI tyy <br /> Date Title Ut ce, P(QSt� l t <br /> STATE OF COIL)f a d D ) <br /> ss. <br /> COUNTY OF CQd a-mS ) <br /> T e foregoing was acknowledged before e this 1 C7'd^ad� of , 20_&by <br /> IC K �zI � �CtfI as VI CP r/,.&Dt CU I of 2ld tS d'C �nQ <br /> J <br /> I T Cf D My Commission Expires: <br /> Notary Public <br /> MONICA POOLE <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20064049340 <br /> MY COMMISSION EXPIRES FEBRUARY 27,201 B <br />