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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 ��,fljhl l�aG'C t C 'KAI lmcmd (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 /> C)�'Aco'�tI'enn <br /> Applicant {i epresentative Namek � _..a �� _ <br /> 1_ <br /> Date y� �1S2� U Z Title <br /> STATE OF Co o ) <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of S� P 6P/ , 20Z, by <br /> r P� J Jre' AUPv-t as of y`��457IP SU/c7��ci 1�G . <br /> dljq Y'd iere6 <br /> My Commission Expires: /�D�• / / 1�/9 <br /> Notary Public <br /> =GEENEVIEVE ."LECHA <br /> JBLICORADO914003259es April4,2019 <br /> C7 <br />