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� .X C. <br /> V <br /> CERTIFICATION <br /> The Appliat Turquoise Conncection (print applicanUcompanynane), <br /> by Foster G.Scott (print representative's name),as President <br /> (print <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 stmcture(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 H (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 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 /> ACKNOWLEGEDttBY: <br /> Applicant71e Tag 4uoife CalLNec fi`dRepresentativeName ( -{"PR &• S Co >t <br /> Date 94— I Title like 5•c{/.Cil/.71 <br /> STATE OF QREGOn1 ) <br /> ss. <br /> COUNTY OFA/1116Q ) <br /> The foregoing was acknowledged before me this IS day of''T 20/' by i fi <br /> FDSIee SC`/6Tl as PR651nGil)i of IT)RiiI)I P�k/J ' <br /> (z77oitl <br /> iiii“eluntueani My Commission Expires: 0418f c�Q <br /> tary P <br /> mit. <br /> .•��'. OFFICIAL STAMP <br /> VICKI LYNN CUNNINGHAM <br /> NOTARY PUBUC-OREGON <br /> COMMISSION NO.947584 <br /> MY COMMISSION EXPIRES FEBRUARY 18,2020 <br />