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CERTIFICATION <br /> The Applicant, Wh-, )eLAlr- er- 9))q , file J. 60Y 0, (print applicant/company name), <br /> byMC_,jrk &Arjj^,ef (print representative's name),as II (print <br /> representative's title),does hereby certify that TAk UeV11,/r''-e 5 (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 GUA K rs o;,i P, v e(-t�ti ve (operation name), <br /> File Number W00 -Q` <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: J f <br /> Applicant Representative Nanie �� k G��rc!1 n -t <br /> Date 3- 6 ' Title V . <br /> 1 <br /> STATEOF CpIQfajD ) <br /> )ss. <br /> COUNTY OF M e Sr, ) <br /> The foregoing was acknowledged before me this day of rCK ,20 k,by <br /> NVAf k 6codnc+ ash ►CCf)JCs 1d ent Of WhAtu-�e i?x6Idi 1'1 OL4-VJ6451 COT. <br /> 11(�G V� �j�C( /�_ tiIy(�nmm���iv:EnpircJ: 11-l4-al <br /> Notary Public <br /> �rsRHEDA V. MASLYK � <br /> NOTARY PUBLIC li <br /> STATE OF COLORADO <br /> NOTARY ID#20174046992 <br /> My Comminion Expires November 14,2021 <br />