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CERTIFICATION <br />The Applicant, Western Slope Materials LLC, by Sean Mello, as General Manager, does <br />hereby certify that ",jb s 4.aa.r W a CL+cst;r, f /.3' Pt TT s (structure owner) shall be <br />compensated for any damage from the proposed mining operation to the above listed <br />structure(s) located on or within 200 feet of the proposed affected area described within <br />Exhibit A, of the Reclamation Permit Application for Blue Pit, File Number M-1981-207. <br />This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br />tinder the Colorado Land Reclamation Act for the Extraction of Constntction Materials and the Colorado <br />Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. Any alteration or <br />modification to this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: C <br />Applicant 3-r�a -J <br />S W P t N^/► � ER r /� i s <br />L < Representative Name . S -A -j %''f <br />Date 1 l 1 t I( Cc Title C'i-C- 1.0 e/L.4 I`'ltr.,.6--6 trti <br />STATE OF Co 11JP <br />ss. TIMOTHY OLK <br />COUNTY OF Gal Notary Public <br />State of Colorado <br />Notary ID # 2018403840r <br />My Commission Expires 10-08.202 <br />The foregoing was acknowledged before me this I day of N64x- , 20 IL, by <br />ScA.J <br />JOA ELLO as Car'Aod,�P&- P4APP"Vk-of Lj.;3;T-X—J gWft Poi+ c.c.s►.t_r L4. C- <br />r' My Commission Expires: /0 �Z0 <br />Notary Public <br />