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CERTIFICATION <br />The Applicant, Western Slope Materials LLC, by Sean Mello, as General Manager, does <br />hereby certify that 4ok-4 e Ras s L az mG K (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 />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 PE MIT APPLICANT <br />ACKNOWLEGED BY: <br />les*ttL�.] <br />Applicant <br />Qt_. PZ MATt IIFtS <br />« Representative Name t A - <br />Date i L 11 I ( �. Title G i a% f'LA L M 4N M (6 e A— <br />STATE OF 0,J0 <br />/ <br />COUNTY OF 64, ked } ) ss. <br />TIMOTBP b1 cK <br />Notary <br />state of Colorado <br />Notary 1D # 2018es 10a06 -2D20 <br />08 <br />My COMMj,,Slon Ex <br />The foregoing was acknowledged before me this I day of Nov44-' , 20 IL, by <br />as E���rcat M .WA -c f4 ��� Cf wc¢��,E►�� u � � <br />My Commission Expires: !0LZO <br />Notary Public r <br />