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CERTIFICATION <br /> The AppliTurquoise Connection (print applicant/company name), <br /> byFoster G. Scott (print representative's name),as President (print <br /> representative's title),does hereby certify that powerline AREA (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 11 (operation name), <br /> File Number M-2007A31 . <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 Construcdmn Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rocky Metal and Designated Mining Operations. <br /> Any alteration or modifreadon to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: � <br /> Applicantl hR Jur;ogo Sz Ccxly-etti_kRepresentativeName <br /> Date q— 1�— SO 1 7 Title A e 5; <br /> STATE OF ) <br /> ss. <br /> COUNTY OF BA k&e ) <br /> The foregoing was acknowledged before me this /f day of__6C-P--1 ,20_a by <br /> 6-MN 0 <5L 7 as_ PRC5//)EM7T of T (%)A1/lF�T10A) <br /> y Commission Expires: U2ll ! <br /> Notary Public <br /> OFFICIAL STAMP <br /> VICKI LYNN CUNNINGHAM <br /> . NOTARY PUBLIC-OREGON <br /> COMMISSION NO.947584 <br /> MY COMMISSION EXPIRES FEBRUARY 18,2020 <br />