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CERTIFICATION <br /> The Applicant, Bestway Concrete Company (print applicant/company name), <br /> by Mark Johnson _(print representative's nan e) a,VP Aggregates (print <br /> LLj,1Y1 -)/ zt-j <br /> �epresentative's titlej, does 1zer41��' rc rtifi that WFan44ra--Sterm0i"Qit.1 (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 Lupton Meadows Gravel Mine _ (operation name), <br /> File Number M-2016- 076 . <br /> This farm has been approved by the Colorado Alined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the E.wraction of Construction Materials and <br /> the Colorado Alined Land Reclamation Act for Hard Rock,Metal, and Designated Alining Operations. <br /> Any alteration or modification to this form shall result ill voiding this farm. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLF,GED BY: <br /> Applicant Bestway Concrete Company_ __ Representative Name Mark Johnsdn <br /> Date November , 2016 Title VP Aggregates <br /> STATE OF <br /> ss. <br /> COUNTY OF <br /> The foregoing was ackno,.vledgged before me this 7 day of U�'c►�a� 20 16 , b� <br /> as r. g f _ of' Aeyi>vr�,� <br /> My Commission Expires: qt iz l`( <br /> Notary Public b <br /> ANDY RODRIGUEZ <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> N <br /> My Commission Expires on t 11 <br />