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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 /> Craig D.6 Roseann L.Engah4p and Robert A&Judkh L.Cadigan <br /> representative's title), does hereby certify that (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 /> ACKNOW D BY: <br /> Applicant A A Representative Name Jerald Schnabel <br /> Date September 1, 2017 Title President of Transit Mix Concrete Co. <br /> STATE OF Colorado ) <br /> ) ss. <br /> COUNTY OF-ft 2)-Zr) - ) <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 /> (V)(�.x 0 <br /> My Commission Expires: Oa- aa- 19-00 <br /> No tW P-u-b li <br /> KAY SANCHEZ <br /> NOTARY PUBLIC <br /> NOTATE RY ID 2 �RAD 002949 <br /> My Commission Expires 02-22-2019 <br />