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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.sand 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 !. / G��LQ Representative Name <br /> Date �lr� — / Title <br /> STATE OF <br /> /� <br /> ) <br /> COUNTY OF Qo Z14 ) ss. <br /> The foregoing was a mowledged before me this day of /tJd</ 20 by <br /> DAi1,i J-, erAuQffg&I as M R-/f QM _of .4!/GJl <br /> My Commission Expires: <br /> Notary Public <br /> THOMAS MARONEY <br /> Nbtety Public-State of Colorado <br /> Nbtbry ID 20104006240 <br /> My tbrrth W0h Expires Feb 28,2022 <br />