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CERTIFICATION <br /> The Applicant, Oldcastle SW Group, Inc. dba B&B Excavating, by Pete Siegmund, as <br /> Assistant Secretary, does hereby certify that k) (structure <br /> owner) shall be compensated for any damage from the proposed mining operation to the <br /> above listed structure(s) located on or within 200 feet of the proposed affected area described <br /> within Exhibit A, of the Reclamation Permit Application for Carol Ann Pit, File Number M- <br /> 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 A ct for the Extraction of Construction Materials and the Colorado Mined Land <br /> 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 /> ApplicantaVjc, gcg E>c cr�,�c�t n representative Name'14 <br /> c <br /> Date Je.{ 4emem )� �g Title 1 C Q <br /> STATE OF <br /> ss. <br /> COUNTY OF i°SCi ) <br /> The foregoing was acknowledged before me this 1Sf'�day of 2yleg h,-f , 20/� , by <br /> as V�� �e5 E'Nf ofC'R ��Su/Cs�ou��l•�cA <br /> �1LAvl/f n/ <br /> My Commission Expires: ��� <br /> Notary Public <br /> GENEVIEVE Pd.BLECHA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#19914003259 <br /> My Commission Expires April 4,2019 <br />