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CERTIFICATION <br /> The Applicant, JH Sand &Gravel, LLC (print applicant/company name), <br /> by Jim McCuistion (print representative's name),as President (print <br /> representative's title),does hereby certify that Gerald & Norma Korinek (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 JH Sand &Gravel, LLC (operation name), <br /> File Number M-M1979 - 131 <br /> This form has been approved by the Colorado Mined Land 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 /> '/� <br /> Applicant JH Sand &Gravel, LLC Representative Name w" <br /> Date I - - 2.0l4 Title President <br /> STATE OF CA ) <br /> )ss. <br /> COUNTY OF ,c,� J/ ) <br /> The foregoing was acknowledged before me this4day of JO c- ,20 19,by <br /> J:m SRC et11 >l-toi as \ (.o o of J N ( x\n9 Li"? <br /> p,M My Commission Expires: `S (a-} <br /> Notary Public <br /> ANGELA MARIE ALWIN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20164022167 <br /> MY COMMISSION EXPIRES MAY 24,2022 <br />