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PERM ITTEE/STRUCTURE OWNER AGREEMENT <br /> State of Colorado, Mined Land Reclamation (MLR) law requires the permit applicant(operator/permittee) <br /> to agree to reimburse the owner of any permanent man-made structure(s)within 200 feet of the permitted <br /> mining area for damage done to the structure(s)as a result of the permitted operation. <br /> L.G. Everist, Inc. believes Hall Family Partnership Firestone LLP <br /> C/O Lot Holding Investments LLC, own the following structure(s), located within 200 feet of the permitted <br /> mining area: Wire fence along county road 13. <br /> L.G. Everist, Inc. agrees to reimburse you for any damage done to the listed structures as a result of the <br /> mining operation. Your acknowledging signature and a notary seal in the spaces provided below shall <br /> satisfy the MLR law requirement. L.G. Everist, Inc. certifies this agreement as follows: <br /> CERTIFICATION: The Applicant, L.G. Everist, Inc., represented by Lynn M. Shults, as Regulatory <br /> Manager, does hereby certify that Hall Family Partnership Firestone LLP <br /> C/O Lot Holding Investments LLC, shall be compensated for any damage from the proposed mining <br /> operation to the above listed structure(s) located within 200 feet of the permitted mining area described in <br /> the MLR Permit for Carbon Valley Resource(M-2001-017). <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant: L.G. Everist Inc 7321 E 88th Avenue Suite 200, Henderson, CO 80640 <br /> Representative: Lynn M. Shults Re ulato Manager, office-303-2 36-2247 <br /> Signature: Date: 67 /l l � Cynthia Antrim <br /> Notary Republic, State of Colorado <br /> STATE OF Colorado ) My Commission Expires February 19,2020 <br /> )ss Notary ID:20084005737 <br /> COUNTY OF Adams ) <br /> The foregoing was acknowledged before me this � day of�'L�`�' 12016, <br /> by Lynn M. ShuIt5 as Regulatory Manager of L.G. Everist, Inc. <br /> Notary Public: ` �L�d z 1. �_ �.tii-7Z e 2)My Commission Expires. <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Hall Family P rtne s ' F e LP Contact name(print):�+'e t-�a-f I <br /> Signature Date: as; ao) 1, <br /> STATE OF t7 ) <br /> )Ss <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this �5kzj�,J day € 2016, by <br /> Notary Public: My Commissio D'UI NAk M-RAFT --- <br /> NOTARY PUBLIC <br /> STATE OF COLORA00 <br /> NOTARY ID#19964021059 <br /> MY COMMISSION EX P RES DECEMBER 06,2016 <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED PAIL # 7014 2870 0001 0807 9813 <br />