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CERTIFICATION <br /> The Applicant, Kilgore Companies dba Peak Materials (print applicant/company name), <br /> by Russell A. Larsen (print representative's name),as C.O.O. (print <br /> representative's title),does hereby certify that Summit County (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 Mascot Placer (operation name), <br /> File Number M-1998-052 <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 /> ACKNOWLEGED <br /> 41Z1 <br /> BYApplicant # v 4-- epresentative Name sa, / <br /> At <br /> 4 A <br /> Date /'-'j/g Title ,6 . Q . <br /> STATE OF ebI b1o4U ) <br /> )ss. <br /> COUNTY OF /AWL- ) <br /> The foregoing was cknowledged hefore me this]day of J ,20 I ',by <br /> lRt.r.61c Jj) e. Z Outa.e-tA as C-60 of . <br /> I A villr' My Commission Expires: 3 I 'Z.t ) ' c <br /> Notary Public 4 <br /> RHONDA BUSCH MORGAN <br /> Notary Public-State of Colorado <br /> Notary ID 20174012396 <br /> My Commission Expires Mar 21,2021 <br />