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S7 <br /> CERTIFICATION <br /> The Applicant, Turkey Canon Quarry Inc., by Nt a ►, ,�. �,f_ _� a � t �. 1_s_` ,does hereby certify <br /> that Andrew Grau _(structure o«ners)shall be compensated <br /> for any damage from the proposed mining operation to the above listed structure(s) located within 200 feet of the <br /> proposed affected area described within Exhibit A,of the Reclamation Permit for Vollmer Pit, <br /> File Number M-1983-035. <br /> Signature of Applicant.- <br /> 4 <br /> Ais fornt has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br /> under the Colorado Land Reclamation Act for the Extraction oj'Construction Materials and the Colora(lo Mined <br /> Land Reclamation Act for Hard Rock, Metal, and Designated 1fining Operations.Any alteration or nto(Itfication to <br /> this_forrn shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant: awl- dP.� tGRQ'Q-d � Representative Name: �Qu�V,Q_ <br /> (Please print) (Please print) <br /> Date: 0(;C 7 el— q 10 Title: <br /> STATE OF COLORADO } <br /> ) SS. <br /> COUNTY OF El PASO ) <br /> O <br /> The foregoing was acknowledged before me this.—A day Ambo-,_ , 2018, by <br /> JI 4 't MO,4,61;�_ as�.(J� WYAJT- of� GA7JDO NAA"-� t G <br /> (si tore of onner or representative) (title) (company name) <br /> -(_ My Commission Expires: <br /> Notary Public Signaturc <br /> ERIC S HOWARD <br /> Notary Public <br /> State of Colorado <br /> Notary t0 N 20144021884 <br /> My Commission Expires 05.30-2022 I <br /> i <br /> Page 2 of 3 t <br />