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v N1 <br /> CERTIFICATION <br /> The Applicant,Turkey Canon Quarry Inc.,by M Az u- .,c_ �- as tr, does hereby certify <br /> that DAVID B OR PENNY S MILLER (structure 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 /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br /> under the Colorado Land Reclamation Act for the Extraction of'Construction Materials and the Colorado Mined <br /> Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations.Any alteration or modification to <br /> this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant: 'TIAW (400 (�t�i�.�� Representative Name: wu tY\ L <br /> (Please print) (Please print) <br /> Date: OC�T'�be�- "t Title: VJ(j J U&Q0 <br /> STATE OF COLORADO ) <br /> ) ss. <br /> COUNTY OF El PASO ) <br /> The foregoing was acknowledged before me this day of Dmw , 2018, by <br /> asAl U WAX of WDO &U,M,9-q t,,�l(I <br /> (si ture of owner or representative) (title) (company name) <br /> My Commission Expires: 3D ��-�' <br /> Notary Public Signature <br /> ERIC 5 HOWARD <br /> Notary Public <br /> State of Colorado <br /> Notary 10 A 20144021884 <br /> M Commission Expires 05-30-2022 <br /> Page 2 of 3 <br />