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CERTIFICATION <br /> The Applicant, Western Slope Materials LLC, by Sean Mello, as General Manager, does <br /> hereby certify that Do�or�c 5 (o€r) CZ..a:JDcgBtE znJ6;T (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 PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant We sr8rt.3 '5.0 r t rtPnt414�_epresentative Name �S t AJ L-3 <br /> Date 1 t t ( l lv Title C►1- IA L VAA.tis A— cr�— <br /> STATE OF TIMOTHY OLK <br /> ss. Notary State of Colorado <br /> COUNTY OF G��e.(� ) Notary 10#20164038408 <br /> M Commission Expires 10 06 2020 <br /> The foregoing was acknowledged before me this I day of 0ovµ•6e r , 20 1 to, by <br /> Sj�:o„J Ll%�:��o as Cst�,�wa� w� ti of <br /> lJ a s r(j 2,J s w/t T'1 p TLr 2 t.4 L t C L <br /> rblic <br /> My Commission Expires: C)A /ZO <br /> Notary P <br />