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e .y <br /> S16 <br /> CERTIFICATION <br /> The Applicant,Turkey Canon Quarry Inc., by N►A 4 k, as Vi p� s�v�-^--;does hereby certify <br /> that NICHOLAS A OR EBONY L CAUGHRON (structure owners)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 ofApplica <br /> This form has been approved by the Colorado Milled Land Reclamation Board pursuant to its authority <br /> under the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Mirred <br /> Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations.Any alteration or modification to <br /> this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant: law' , 00 Qt44R�¢—J �!(� Representative Name: �l Cy1QQ.�.���,P. <br /> (Please print) (Please print) t <br /> Date: OC �beX �1 20 Title: V J CJ J K(&00 <br /> STATE OF COLORADO ) <br /> ) ss. <br /> COUNTY OF El PASO ) <br /> The foregoing was acknowledged before me this" day of Dmw , 2018, by <br /> �r w4::C' MjWA� as VL1J WVAX of kJ DO &WW!Pa I,I NG. <br /> (si ture of owner or representative) (title) (company name) <br /> My Commission Expires: &AA3D I �2�-- <br /> Notary Public Signature <br /> ERIC S HOWARD <br /> Notary Public <br /> State of Colorado <br /> Notary ID# 20144021884 <br /> My Commission Expires 05-30-2022 <br /> Page 2 of 3 <br />