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CERTIFICATION <br /> The Applicant, Carol Ann Pit, LLC, by Robert W.Newby& Carol Ann Newby, does hereby <br /> certify that JHoly Cross Energy (structure owner) shall be compensated for any damage from <br /> the proposed mining operation to the above listed structure(s)located on or within 200 feet of <br /> the proposed affected area described within Exhibit A, of the Reclamation Permit Application <br /> for Carol Ann Pit, File Number M-1997-026. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority under <br /> the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado M PEEVED <br /> Reclamation Act for Hard Rock, Metal, and Designated Mining Operations Any alteration or modification o <br /> this form shall result in voiding this form. <br /> FEB 0 8 2019 <br /> NOTARY FOR PERMIT APPLICANT <br /> DIVISION OF RECLAMATION <br /> ACKNOWLEGED BY: <br /> Ev,,iAING AND SAFETY <br /> Applicant_Carol Ann Pit, LLC Representative Name <br /> Date _ 4 _ Title ►'I 1.0 gk 6 Q <br /> STATE OF 6 ) <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me thiseday of ,20 by <br /> /�/Cl as�M- MJ2!_V of �,Gi- Avw,, Pcf-.LLC— <br /> A, w 4 g ltt I <br /> GL My Commission Expires: a/a 7 l�� <br /> otary Public <br /> DANETTE M SCHLEGEL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NMARY ID 20034006913 <br /> My Commission Expires February 27,2019 <br />