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RPM,Inc. <br /> CERTIFICATION <br /> I'he Applicant,Elbert County Government_Elbert County"County'%does herby certify that Elbert Countv <br /> Government'Properr Owner'shall be compensated fur any damage from the proposed mining operation to the <br /> above listed structures(s)located on or within 200 feet of the proposed affected area described within Exhibit A,of <br /> the reclamation Permit Application for the Permit No.M-2001-056 Belveal Gravel Pit <br /> 77ris farnn has been approved by the Colorado Mined Land Retlainaunn Board pursuant to its authorial•under <br /> the Colorado Land Reclamation Act for the Extracdon of Construction 3laterials and the Colorado.lfined Land <br /> Reclan:a tin a Act fur Hard Ruck,Alvial,and Designated ARAinq Operations. Aiti,alacration or modification to <br /> this fornn shall re.5ult in voiding this form. <br /> NOTARY FOR PF.RNIi'f'APPLICAA.\1' <br /> ACKNOWLFDGEDBY: - <br /> r <br /> ` t � <br /> ,Applicant: Elbert County Government Representative Namel_�rF{��l <br /> Date �s .��r�Lt IWe �lL c? :+?iJNt7C:�5-i_ O1 -tn�air 1',nG w� <br /> STATE OF <br /> COUNTY OFt-' <br /> The foregoing vas acknowledged beforq in:this `. day oG�''-_;_ .20 by is, <br /> or <br /> k0k,Commission Expires - J <br /> CZ <br /> `.J'ar•�unl c �ta'r_of Calora;:<-, <br /> riva;io:aca`:nt�osi O`l'ARY STRUCTURE OWNER <br /> nn Ftp 2-.nn 9.202i <br /> AC'KNOWLEU01-1)RN': <br /> Structure Ot+uer:Elbcrt County Government Representative None: <br /> rrI <br /> Uatc <br /> f� I�1�`� Title <br /> STATE OF ? <br /> COUNTY OF j <br /> The tiuegomg tras acknowledged before we this___ day of_ -__ .20_.by as <br /> of <br /> Nly Comatission Expires: — <br /> Notary Public <br /> 11 <br />