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CERTIFICATION <br />The Applicant, Hard Rock Paving and Redi Mix, Inc. <br />print applicant/company name), <br />by John Paul Ary print representative's name), as President print <br />representative's title), does hereby certify that Orlando Martinez 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 Leone Gardner operation name), <br />File Number M-1985-008 <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 />ACKNOWL 1 Di Y: <br />Applicant ; I _ Representative Name ZONA VAT-4 <br />Date Title Predithqr <br />STATE OF CDU 1 ) <br />ss. <br />COUNTY OF j^pyripKi- ) <br />The foregoing was acknowledged before me this <br />ed <br />day of 00b61,1, , 20 11, by <br />aM P Arti i'as nnIre biith.4- of -0-anl kae1C -At ! R j <br />niii) <br />i <br />9(: /'........--S-1...—My Commission Expires: /0)(p//$ <br />Not ublic <br />JODI D SCHREIBER <br />NOTARY PUBLIC-STATE OF COLORADO <br />My Identification#20064001792 <br />Expires atter 6,201E