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Ul <br />CERTIFICATION <br />The Applicant, Turkey Cation Quarry Inc., byr k,4-zy-_ Mo asy, c� P,2 ,—o ----, -does hereby certify <br />that WOODMEN HEIGHTS METRO DIST NO i (s(ructure owners) shall be compensated <br />for any damage from the proposed mining operation to the above listed structure(s) located within 200 feet of the <br />proposed affected area described within Exhibit A, of the Reclamation Permit for Vollmer Pit, <br />File Number M-1983-035. <br />Signature ofApplica"- <br />- <br />Thus form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br />under the Colorado Laud Reclamation Act for tire Extraction of Construction Materials and the Colorado Mitred <br />Laird Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. Any alteration or modification to <br />this form shall t•esult in voiding this farm. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />01 <br />Applicant: � uy <br />WWOO (LGIt � fL Representative Name: K ry1 (, v. . <br />O .. ��� <br />(Please print) (Please print) <br />Date: 0CXA2lV- - 20 <br />STATE OF COLORADO ) <br />) ss. <br />COUNTY OF El PASO ) <br />Title: <br />The foregoing was acknowledged before me this '�A day of DMKI , 2018, by <br />N -(' NIA•E. as l(.� UWAS of} G + i I <br />ANDAA0,-1 f G , <br />(si ture of owner or representative) (title) (company name) t <br />My Commission Expires: 3,o 2{i2q— <br />Notary Public Signature <br />ERIC S HOWARD <br />Notary Public <br />State of Colorado <br />Notary 10 0 20144021884 <br />My Commission Expires 06-30-2022 <br />Page 2 of 3 <br />