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CERTIFICATION <br />The Applicant, Westem Slope Materials LLC, by Sean Mello, as General Manager, does <br />hereby certify that C-42_ r -J T u R It l { ,J 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 hoard pursuant to its authority <br />under the Colorado Land Reclamation Act for rhe F—ttraction of Construction Materials and the Colorado <br />Mined Land Reclamation Act for Hard Rocl, Metal. and Designated Mining Operattons. Any alteration or <br />modification to this fornr shall result in voiding this form. <br />NOTARY FOR PEEWIT APPLICANT <br />ACKNOWLEGED BY:=' �v <br />W. r'erL J St att rK►r:ti+ <br />Applicant r. " Representative Name 5 c Aj PAZt L- ';I <br />Date t 4 11 � x '_.. Title <br />Gr' j * v-k� wAr.—r-C-'e.1 <br />STATE OF L. l -,Jo ) TIMOTHY O L K <br />f } 5s. W -181y Public <br />COUNTY OF_ 1 ,j s:asrr ct 01640x_ <br />�wr rt' NJld,y fD+2U1�403H46tj <br />!ay t .mmiaron F.+ores W UB 2U2Q <br />The foregoing was acknowledered before me this I day of N. vu- Let- , 20 I L, by <br />c L L. , a5=t...s�n.a � lI'tAr.-lkl.�-r+Af �.l} S C� M1� s, O t r j -A h-Tti 1L. R L - S --e- <br />__ �_-- ��#_ My Commission Expires: 1 01r. 406 <br />Notary Public <br />