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U3 <br />CERTIFICATION <br />The Applicant, Turkey Carlon Quarry Inc., by a� le j, ,_ t as kr-does hereby certify <br />that MOUNTAIN 111EW Ei0jR#C M80C)Aff) 1. (structure owners) shall be compensated <br />for any damage from the proposed mining operation to the above listed structures) located within 200 feet of the <br />proposed affected area described within Exhibit A, of the Reclamation Permit for Vol liner Pit, <br />File Number M-1983-035. <br />Signature ofApplican <br />This form has been approved by the Colormlo Mined Lund Reclamation Board parsuant to its authority <br />under the Colorado Land Reclamation Act for the Extraction: oJ'Construction Materials and the Colorado Mined <br />Land Reclamation Act for Haid Rock, Metal, anal Designated Mining Operations. Any alteration nr- modification to <br />this fornn shall result in voiding this foam. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOW LEGED BY: <br />Applicant: � NOAH Virg ��jrf(� Representative Name:fou mau.E` , Q, <br />(Please print) (Please print) <br />Date: OC4-10120- R 2© <br />STATE OF COLORADO ) <br />) ss. <br />COUNTY OF EI PASO ) <br />Title: _ L4 0 <br />The foregoing was acknowledged before me this day of wlv� , 2018, by <br /><84W of <br />(si tureof owner or representative) (title) (company name) <br />My Cotnunission Expires: tyVAA 3D Ir�V2� <br />Notary Public Signature <br />ERIC S HOWARD <br />Notary Public <br />Stole of Colorado <br />NotafylD # 20144021684 <br />NIX Commission Expires 05.30-2022 <br />Page 2 of 3 <br />