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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 I(l (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 Act 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 /> oAaconttsz 5U3 b1bo <br /> Applicant Ex Jj a' Representative Name <br /> Date 5P4) InLQf DK)Z Title Via `1" Imo' 'k dal l I <br /> STATE OF t Y3 t ) <br /> ss. <br /> COUNTY OF A 0 ) <br /> The foregoing was acknowledged before me this � day of l � , 20f�, by <br /> as of <br /> � V LnCad�f.gJt <br /> L /k 14 My Commission Expires: )4/1 <br /> Notary Public <br /> E <br /> VIIEVE 1V1.BLECHAOTARY PUBLICTE OF CO�ORADORY ID#19914003259ssion Expires April4,' �� <br /> oo <br /> P <br />