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CERTIFICATION <br /> The Applicant, Western Slope Materials LLC, by Sean Mello, as General Manager, does <br /> hereby certify that L,%.p n rA M sk+-b P / : , M A t T t s (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 /> tinder 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: '�; K;� <br /> S-a P r` N^/r r E/Z'i '- -r <br /> Applicant < < Representative Name <br /> Date 1 �t /� Title C-r C e- 114.A,4-6 t-ti <br /> STATE OF Co I orcxJv ) <br /> ss. =NotarylD <br /> OLK <br /> oil � blic <br /> COUNTY OF �• orado <br /> 4038408 <br /> res 10-06.2020 <br /> The foregoing was acknowledged before me this day of N&,-t«+64x- , 20 IL, by <br /> JcX,J 1'� E��p as �r wo&tip, wt,�N,F6crkof lJlsfk�tia S�?t c�-t.+ !Es/t ,ail c <br /> My Commission Expires: 10 /20 <br /> Notary Public <br />