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CERTIFICATION <br /> The Applicant, Oldcastle SW Group, Inc. dba B&B Excavating, by Pete Siegmund, as <br /> Assistant Secretary, does hereby certify that e� structure <br /> owner) shall be compensated for any damage from the proposed mining operation to the <br /> above listed structure(s) located on or within 200 feet of the proposed affected area described <br /> within Exhibit A, of the Reclamation Permit Application for Carol Ann Pit, File Number M- <br /> 1997-026. <br /> This form has been approved by the Colorado Alined Land Reclamation Board pursuant to its authortty under <br /> the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Mined Land <br /> Reclamation Act for Hard Rock, Aletal, and Designated Alining Operations. An},alteration or modification to <br /> this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> OI�C0.gt1�SItJ (2) �In� •&oA <br /> Applicant$c3 Fxccj Q Representative Name <br /> Date Seai '�,c� Title V I <br /> STATE OF <br /> ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this/,C-//)day of_ 20 /f by <br /> as G<<� !/f5��i°yf of G�C45f�ESi� t�u �L"tom <br /> My Commission Expires: q <br /> Notary Public <br /> GENEVIEVE M.BLECHA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#19914003259 <br /> My Commission Expires April 4,2019 <br /> �P <br />