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CERTIFICATION <br />The Applicant, Western Slope Materials LLC, by Sean Mello, as General Manager, does <br />hereby certify that Lj IF�T-aA_j 5,..,, ft *KA rd.t •oAL r L t r, (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 -198I-207. <br />This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br />under the Colorado Land Reclamation Act for the Extraction of Construction 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: <br />r� �CsTSrLS) S4> Pr' M�f r-drt'LcS <br />Applicant" L- � � Representative Name L c_ 0 <br />Date ! r (1 ((0 Title & Z &.a .� "- s, _ OA a.� kC� & A -- <br />STATE OF CaI ) TIMOTHY OLK <br />Notary Public <br />it - a�d ) ss State of Colorado <br />COUNTY OF <br />ct � � ) Notary ID #120184038408 <br />My Commission Expires 10-06-2020 <br />The foregoing was acknowledged before me this day of Now--4gr 20 jG , by <br />YAC t_ as tie AA,.. MAwA,w4e*-of_ —xsrae—y 5, -*14 MA-lVoLtAL—C <br />My Commission Expires: 1d L <br />Notary Public <br />