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CERTIFICATION <br /> The Applicant, rn c Qrrn L Ck ?,( o Ct-yQt-on h�C�`u��C Lt(( (print applicant/company name), <br /> byj aM Q 1, M C CLt(11 WCL (print representative's name), as i �� ('KC ryl�,Qy (print <br /> representative's title), does hereby certify that t C a kc, ks Co. (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 Ste Lon, �� �/ (operation name), <br /> File Number <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 (� (�E Y rye c e l� �+ 1 16�,epresentative Name /ry�a S I J.l C'�_0 rm 104 <br /> Date Title "na-g t.o G M m/e"'- <br /> sTATE-o-FL(crac o ) <br /> )ss. <br /> COUNTY OF V6Q ) <br /> The foregoing was acknowledged before me thisc2l%rday of 20 /�, by <br /> J0mo-s M(Tyratet as Al.a.a of (YtiV"MwL 0-a-6(1, (A ipa-u1,W) <br /> M Commission Expires: lo - 17-17 <br /> % Y p <br /> No Public <br /> JILL MASTERS <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID# 19974010957 <br /> MY COMMiSSION EXPIRES JUNE 19,2017 <br />