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CERTIFICATION <br /> The Applicant, Daniel J. Gaudreault & Barbara J. Gaudreault (print applicant/company name), <br /> by,DenW J. Gaudreautt {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_0$1 , <br /> This form has been approved by the Colorado Mined.'.and Reclamation.hoard 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 PERNUT APPLICANT <br /> ACKNOWLEGED BY. <br /> 1z, <br /> 0 1 <br /> Applicant 12,,�t / `' " �Representative Name l <br /> Date Title <br /> STATE OF � ) <br /> ) SS. <br /> COUNTY OF ) <br /> The foregoing was knowledged before me this, day of_ G _ . 20lyby <br /> u tr2�ib-as M o41f,? ► _of R; �''G' ,"cry At r <br /> My Commission Expires, <br /> Notary Public <br /> THOMAS MARONEY <br /> #d+tety Public-State of Colorado. <br /> +OWY ID 20104006240 <br /> AvlY Cott;miireW Expires Feb 28,2022 <br />