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S40 <br /> CERTIFICATION <br /> The Applicant,Turkey Cation Quarry Inc.,by to 4oz y asV ►�n ,-does hereby certify <br /> that ADAM OR MICHELLE SCHUBERT {structure owners)shall be compensated <br /> for any damap from the proposal mining operation to the above:listed sirtuftre(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 Mined Land Reclamation Board pursuant to its authority <br /> under the Colorado Land Reclamation Act for the Fa-fraction of Construction Materials and the Colorado Wined <br /> Land Reclamation Act for Hard Rock,Metal,and Designated Wining Operations.Any alteration or modification to <br /> this fornr shall result in voiding this form, <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant: Ul ,. G�R1►104 R-`i . L Representative Name: IVY I r-bu <br /> (Pleaw per) (PIem pint) <br /> Date: OGT` OL Q 74 Title: Vi(j <br /> STATE OF COLORADO ) <br /> )Ss. <br /> COUNTY OF El PASO ) <br /> The foregoing was acknowledged before me this day of , 2018,by <br /> as-4( '� ofIWO GIN Ot+I."49-4 <br /> (si of owner or repm- ative) (title) (Company rame) <br /> 71UVA%ac - <br /> My Commission Expires: 3D I�q-^' <br /> Notary Public Signature <br /> ERIC S HOWARD <br /> Notsfy Public <br /> Ststo of Colorado <br /> Notary ID R 201440216#4 <br /> M Commission Ex ims 05-30.2022 <br /> Pape 2 of 3 <br />