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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 Mark Arnusch (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 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: (� <br /> Applicant k(AZk4 (_yS{ovy% S�t!uA Representative Name IL I`IIa h <br /> Date V/g b� Title V <br /> STATE OF Cp D ) <br /> ) ss. <br /> COUNTY OF Qd ) <br /> 1�e foregoing was acknowledged before e this �� day of m , 201�D, y <br /> KLCk 6111 QI) as l�C� krx'Lst afTf of 0 An <br /> �..r�rlorl�l C O� P670�P— My Commission Expires: <br /> Notary Public <br /> MONICA POOLE <br /> NOTARY PUBLIC <br /> ST1x E OF COLORADO <br /> N01ARY ID 20064049340 <br /> �!Y COMMISSION EXPIRES FEBRUARY 27�201 <br />