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CERTIFICATION <br /> The Applicant, Transit Mix Concrete Co. (print applicant/company name), <br /> by Jerald Schnabel (print representative's name), as President (print <br /> representative's title),does hereby certify that Richard L. & Susan K. Larsen(structure owner)shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br /> Permit Application for Hitch Rack Ranch Quarry (operation name), <br /> File Number M- - <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNqLE ED BY: <br /> L- <br /> Applica presentative Name Jerald Schnabel <br /> DateSeptember 1, 2017 Title President of Transit Mix Concrete Co. <br /> STATE OF Colorado ) <br /> ) ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this 1st day of September ,20 17, by <br /> Jerald Schnabel as President of Transit Mix Concrete Co. <br /> My Commission Expires: oqDkQ <br /> ary P li <br /> KAY SANCHEZ <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20074002949 <br /> [My Commission Expires 02-22-2019 <br />