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CERTIFICATION <br /> The Applicant, Western Slope Materials LLC,by Sean Mello, as General Manager, does <br /> hereby certify that COS 0 2Ao o A-e P T . OF 't n.Ar 3S Po aT aT`J,-)(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 /> WcsT.ta..� S�-aPd HhT.t'Mpc <br /> Applicant " Representative Name SE a,-J J"t=L-J <br /> Date I 1 l �o Title A-t-Lr A-- <br /> STATE OF TIMOTHY OLK <br /> Notary Public <br /> 1 V ) ss. state of Colorado <br /> COUNTY OF Gu4 J1 ) Notary ID#20164038408 <br /> My Commission Expires 10-06-2020 <br /> The foregoing was acknowledged before me this day of PoveWA6c.r , 20 16 ,by <br /> Stp_ -A P-A< as Gyp- -At tAA."JAt-'''Lof W <sitrL� S­ofE MN-,EtL.ALs <br /> ,M My Commission Expires: -- <br /> Notary Public <br />