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CERTIFICATION <br />The Applicant, Western Slope Materials LLC, by Sean Mello, as General Manager, does <br />hereby certify that T>s,.afLc 5 (tit,) vs,.,j c �L a�,-Ant -TMJ! {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-19$1-207. <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 E.rtraction 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 />7 <br />Applicant Wasca(La s%,pt Ko%remAgepresentativeName S-EA.J 01AL.P- L,J <br />CC L <br />Date 0 (k ( ( L" <br />Title 6 cc p tr-.La L ,a•���, � � �r � <br />STATE OF (JJ* TWOHyOLK <br />SS. Notary Public <br />COUNTY OF [,4I� } State of Colorado <br />Notary IDA 20184039408 <br />MV Commission 1=xpires 10 -OB -2020 <br />The foregoing was acknowledged before me this l day of 0ov-6er< , 20 1(., by <br />5 A. -I ilk ��O a5 �Ur 1`tilw anti Of <br />d S T'L 2 '+1 S W / i 1"'1 FT's 2 1 hL f c L r- <br />My Commission Expires: 10/6 /7,O <br />Notary Public <br />