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CERTIFICATION <br />The Applicant, Western Slope Materials LLC, by Sean Mello, as General Manager, does <br />hereby certify that L, E,z a A A-rj C*� (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 BIue Pit, File Number M-1981-207. <br />This form has been approved by the Colorado Mined Land Reclamation Board ptrrsttant to its authority <br />tinder the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado <br />Mined Land Reclamation Act for Hard Rock,ltfetal, and Designated Mining Operations. Any alteration or <br />modification to thisform shall result in voiding thisform. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />We xrr.a,J <br />Applicant <br />c 9- Representative Name St to a��- <br />Date 11 ( Title <br />STATE OF Colar ) TIMOTHY Ol_K <br />Q I ) ss. Notary Public <br />COUNTY OF Crcr F is rd state of Coloradc <br />Notary ID # 2016403FLkAy <br />Cmnmission Expires t U "'.'020 <br />The foregoing was acknowledged before me this <br />I day of Nvw-.%644- , 20ge, by <br />Se o;,.3 P"c L.L <br />as CT t►xa Axa tea"' "c`4of gf [ E n -Ki S� a 4 t �th-. w&tA L S L L. C <br />Commission Expires: <br />Notary �Publi�c���My <br />