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CERTIFICATION <br /> The Applicant, Van Valkenbur4 Cattle Co. LLC (print applicant/company name), <br /> by William Van Valkenburg (print representative's name), as Manager (print <br /> representative's title),does hereby certify that Jackson County Road&Bride (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 Van Valkenburg Quarry (operation name), <br /> File Number M- - <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 /> ACKNOWLEEGED BY: <br /> Applicant. CA_I�-Kepresentative Name <br /> Van Valkenburg Cattle Co., IT C William Van Valkenburg <br /> Date ��1 w SO&�I t, Title_� '1 i e 2� <br /> STATE OF <br /> ss. <br /> COUNTY ORSAO—K SCII( ) <br /> e foreg ing as cknowledged before me this day oft [l_ , 201 <br /> as t i/T of L�L► <br /> /6L My Commission Expires: <br /> oaryPu c <br />