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CERTIFICATION <br />The Applicant, Western Slope Materials LLC, by Sean Mello, as General Manager, does <br />hereby certify that Cca%..m tia.aQ De Ft . d aptssPdATA 'JP(structure owner) shall be <br />compensated for any damage from the proposed mining operation to the above listed <br />structure(s) Iocated 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 />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 />W,E&.r.rr.A3 e.,_. -ape /"►frT.tMPc <br />Applicant "- Representative Name SC a,J 4 J <br />Date— l 1 h"" Title t. LP n-- <br />STATE OF Carlo ) T1MO�HY OLK <br />Notary i'ublic <br />) ss. State of Colorado <br />COUNTY OF e.ia 1 Notary ifl a tot fiaossaas <br />My Gommisslon ExPlrea 10-46-2020 <br />The foregoing was acknowledged before me this I day of Novaw,6cr , 20 If._, by <br />! €;x P A da as P41.m4tv4'&of W rs i eLtSia'" MA,'iEIL,.AL; <br />My Commission Expires: <br />Notary Public <br />