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`N1 <br /> CERTIFICATION <br /> The Applicant,Turkey Canon Quarry Inc., by y. ,a-z as ice,i 1� Ales,,:-,c 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 ofAppli <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: lad- (600 alGlt�.� Ilf(J Representative Name: K"X— <br /> (Please print) .�.��� ^ (Please print) <br /> Date: OC�TTlbeL j . 20« Title: VE( l (&0l'�N' <br /> STATE OF COLORADO ) <br /> ) ss. <br /> COUNTY OF El PASO ) <br /> The foregoing was acknowledged before me this._I<=__ day of�yi� , 2018, by <br /> " '`""�% as �l(!� ' "thyX of �`1' G fkND�J <br /> (sim3ature of owner or representative) (title) (company name) <br /> My Commission Expires: A3D 1401 --- <br /> Notary Public Signature <br /> ERIC S HOWARD <br /> Notary Public <br /> State of Colorado <br /> Notary 1D 4 20144021884 <br /> My Commission Ex ires.05-30-2022 <br /> Page 2 of 3 <br />