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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 ���+( (�I(l (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 Mined Land Reclamation Board pursuant to its authoritt,under <br /> the Colorado Land Reclamation Act far•the Extraction of Construction Materials and the Colorado Mined Land <br /> Reclamation Act for Hard Rock, Afetal, 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 /> OA6CO,ntLf, 5U3 (DML)P 96c,, <br /> Applicant ' Representative Name J, <br /> Date SPA) LQ.0 q o�d 1g Title V (� I�( �jl(�Q 1�+ <br /> STATE OF t Y ) <br /> ss. <br /> COUNTY OF 1 � .) <br /> The foregoing was acknowledged before me this day of4�Zh1�l , 20A, by <br /> �fFr J. 5�'�q�GluG1� as L',t /��stalPu f of f/ C'Goe S(t/Gtou� f tic <br /> L'nladCrfyy <br /> My Commission Expires:A /, L/ 9 <br /> Notary Public <br /> GENEVIEVE 1v1.B ECHA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#19914003259 <br /> MY COMMission Expires Apo 4,2019 <br /> �� <br />