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r <br /> GENERATOR AFFIDAVIT,CERTIFICATION AND INDEMNIFICATION <br /> STATEMENT <br /> The undersigned Affiant certifies that the information contained in and attached to this profile <br /> is accurate and complete to the best of his/her knowledge,that fill materials to be delivered to this <br /> Aggregate Industries site are clean and inert and that there are no known materials that would <br /> significantly affect the inert nature of the fill materials,nor are there any acid forming materials <br /> or toxic producing materials in said fill materials. Furthermore,by signing this Statement,the <br /> undersigned shall,to the extent permitted by law,indemnify and hold harmless Aggregate <br /> Industries in the event it should be determined that any material provided to Aggregate Industries <br /> is contaminated with any regulated pollutant and/or poses environmental harm. The undersigned <br /> shall,to the extent permitted by law,assume all liability and costs <br /> associated with the removal,disposal and negative impacts of any contaminated material <br /> provided to Aggregate Industries. <br /> Signed this- � l day of J Z-n Q ,20 ) 7 . <br /> Name and Company: 30"l A e r Ce ., +y pk r ks s J O p e-v ! NL<sl <br /> Signature <br /> T^}-cam:.., �@SoK«Q �ly....:..* Ma....sa✓ <br /> Title <br /> STATE OF COLORADO ) <br /> County of <br /> Subscribed and sworn to this�_day of J UNF ,20_L2 by <br /> 444 s4a is- E .as Yn 4f4/,, .of d has Yt. <br /> ,C" MA ka & antAr SPt%ef <br /> Witness my hand and official seal. ERMK WELCH <br /> HOUM PtN= <br /> STATE OF COLORADO <br /> N may 10 0 200 08me <br /> W OOINNINIONl0MIEE 1lNNMIRY 14.2DQO <br /> (SEAL) <br /> Notary Public <br /> My Commission expires: a//y�010 <br /> Aggregate Industries-Inert Fill Materials Profile Form <br /> Page 3 of 3 <br />