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CERTIFICATION <br /> The Appl&a Turquoise Conncection <br /> (print applicandcompany name), <br /> by Foster G. Scott (pit President <br /> representatives name),as (pit <br /> representative's title),does hereby certify that CO. Dept. of Hwy (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 Scott Blue II <br /> (operation name), <br /> File Number M 2007-031. <br /> This form has been approved by the Colorado Mined Land Reclamation Bnard 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 Rocky 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 /> ACICNOWLEGED BY: <br /> Applicant n-e w 1Z 4'u o j fe C vn Nf Representative Name �O`7 -f'p/� �- �• C <br /> Date - r — `��G J'� Title !/le 5•d P��� <br /> STATE OF OR66QAJ ) <br /> COUNTY OF.,8,dy )ss.) <br /> The foregoing was acknowledged before me this /8 day of ,'�'6e-r 20 7 by 7-�� <br /> F�)s IEj2 SG)rk as�'RF<k nGa 1-r of J�(�I�/ll l/a)dJ� 77(jMl <br /> '—ULn71 My Commission Expires: <br /> 4otary Puotary Public <br /> OFFICIAL STAMP <br /> VICKI LYNN CUNNINGHAM <br /> NOTARY PUBLIC-OREGON <br /> !�J COMMISSION NO.947584 44Y COMMISSION EXPIRES FEBRUARY 18,2 <br />