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S3T <br /> CERTIFICATION <br /> The Applicant, Turkey Canon Quarry Inc.,byMa-zy, Mo cr as Vr r, PZEswv does hereby certify <br /> that CARL S BROOKS OR ELIZABETH GARNER (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 ofApplican <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br /> under the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Milted <br /> Land Reclamation Act for Hard Rock,Metal, and Designated Mining Operations.Amy alteration or modification to <br /> this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant; JI&W (404 64*924 .�(� Representative Name: hu rno .L�.�V,�, <br /> (Please print) (Please print) <br /> Date: �C�T`�bG�� Q . Title: Vt(j 1 t&O0 <br /> STATE OF COLORADO ) <br /> )ss. <br /> COUNTY OF El PASO ) <br /> The foregoing was acknowledged before me this" day of�ylw , 2018, by <br /> 0*4-- Mgwe6� as UL(i �WWYV of g14"4 C.ANk1 k4*W <br /> (si ture of owner or representative) (title) (company name) <br /> 5 <br /> My Commission Expires: 3D �V2� <br /> Notary Public Signature <br /> ERIC S HOWARD <br /> Notary Public <br /> State of Colorado <br /> Notary ID tt 20144021884 <br /> My Commission Expires 05.30-2022 <br /> Page 2 of 3 <br />