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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 Crowley County (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-1979- 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, ani,(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 /> eim:A±4;v1 <br /> Applicant_JH Sand& Gravel, LLC Representative Name G <br /> Date 1/14/15 Title President <br /> STATE OF Clo-yxoto ) <br /> )ss. <br /> COUNTY OF e ta.31.Q ) <br /> The foregoing was acknowledged)?efore me this Vellay of_ e _ ,20�r1,1,by <br /> Jtrin r v _exm S+wc as 6Q.5 GL- of__N‘ e io ( ra,,a, <br /> My Commission Expires: S L;x�1a-�— _ <br /> No` Publi <br /> ANG:LA MARIE ALWIN <br /> "'FLA •F• i OTARY PUBLIC <br /> F r_.,r STA E OF COLORADO <br /> 7l NOT Y ID 20184022187 <br /> MY COMMI ON EXPIRES MAY 24,2022 <br /> ''; MY .• SSIGN EXNlktb MAY 44,2022 <br /> , <br />