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CERTIFICATION <br /> The Appli cant, Turquoise Connection <br /> (print applicant/company name), <br /> byFoster G_ Scott (print representative's name),as President <br /> (print <br /> representative's title),does hereby certify that road into the Gold King mTn".•Pqstructure 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 If <br /> (operation name), <br /> File Number M-2007-031 . <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 and DesignateeMining Operations. <br /> Of Construction Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rocky Metal, <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: - <br /> ApplicantT�i��lJiQDtic.tY Co1��/ec6q,/Representative Name <br /> Date �" /4— Z G/ �7 Title !.S-s i. " <br /> STATE OF 6R 6l0A) ) <br /> COUNTY OF26Y&S )ss.) <br /> The foregoing was acknowledged before me this le day of SST ,2017,by T H-r <br /> �05T�/2 Cam— _P,2�s;n T ofT �o l r�l�,t�,tnd <br /> l7/U ' 1 y Commission Expires: e9 <br /> *No _Pub(l�ic <br /> OFFICIAL STAMP <br /> VICKI LYNN CUNNINGHAM <br /> • NOTARY PUBLIC-OREGON <br /> COMMISSION NO.947584 <br /> MY COMMISSION EXPIRES FEBRUARY 18,2020 <br /> 1 <br />