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CERTIFICATION <br /> The Applicant. SEMA Construction,Inc. (print applicant company name). <br /> by Mark W.Brooks (print Iepie;entatire'sname}, a;District Vice President (print <br /> representative's title).does hereby certif}•that Weld County (;tructtlre owner)shill <br /> be compensated for illy daniaae from the proposed liiiliina 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 Reclaination <br /> Permit Application for Betz Borrow Pit (operation name j. <br /> File:`umber N1- - <br /> This form has been approved bt'the Colorado 31ined Land Reclamation Board pursuant to its <br /> authoritt•under the Colorado Laird Reclamation.4et for the Extraction of Construction_1aterials and <br /> the Colorado ►lined Land Reclaination Art for Hard Rork,Veral,and Designated 11ining Operations. <br /> At iv alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PER-NIIT APPLICANT <br /> ACIsNOWLEGED BY: <br /> Applicant SEMA Construction, Inc. Representative Nan;resident <br /> Date 9/12/18 Title District Vice <br /> STATE OF Colorado I <br /> 55. <br /> COLTNTY OF Arapahoe i The foregoing was acknowledged before me this—"i d y 0f5 h t0 l✓ .20��.by <br /> MC;tILin�` t?,:y:iCS as�lStvLct Ll{�.� 1l,1s14Irt, <br /> l- At"-�LSr/s�; Nly Commission Expires: I <br /> Notary Pt blic <br /> NANCY T GUERRERO <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20124067633 <br /> MY COMMISSION EXPIRES 10/19/2020 <br />