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AF z�� <br /> CERTIFICATION <br /> The Applicant, Daniel J. Gaudreault & Barbara J. Gaudreault (print applicant/company name), <br /> by Daniel J. Gaudreault (print representative's name), asOwner (print <br /> representative's title), does hereby certify that Colorado Dept. of Transportation (structure owner) shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br /> Permit Application for Big "G" Gravel Pit (operation name), <br /> File Number M2003_081 <br /> This form has been approved by the Colorado Mined.hand Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock,Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: / � <br /> Applicant Representative Name T <br /> Date Title N/ IV A:P J?. <br /> STATE OF <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was a knowledged before me this day of ®lJO(0 _, 20�by / <br /> O� T, �rptea teAujkas M A/I'rm _of R;a <br /> My Commission Expires: <br /> Notary Public <br /> �wr <br /> THOMAS MARONEY <br /> 6tetV Public-State of Colorado_ <br /> Wtery ID 20104006240 <br /> My tbtbffilMl§h Expires Feb 28,2022 <br />