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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 UAk( Uri\ilNI.C.R.f1lojr�i �I(tructure 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 022 <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 /> ACKNOWLEGED BY: (� �^ /I <br /> Applicant �4�>NO 60 m 5ftd l/ y Representative Name 1\ti�G 61 lla m <br /> Date 5 fll�/l Title Vl Le- r4e-Sidm ' <br /> C <br /> STATE OF eolorado > _ '�— <br /> ) ss. <br /> COUNTY OF Qd amS ) <br /> e foregoing was acknowledged before e this 19 day of S!/l , 20 ,, by <br /> tC4 i 2111an as L11 CCU F/es td—P— )-�' of Q <br /> / / lM 0 0, POO j fQ My Commission Expires: Cq-j X7/f�' <br /> Notary Public <br /> MONICA POOLE <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20064049340 <br /> ,My COMMISSION EXPIRES FEBRUARY 27,2018 <br />