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To: 'DRMS Den Page 7 of 11 2019-04-02 15:59:32(GMT) 13032008630 From: Ben Lange nfeld <br /> - CERTIFICATION _ <br /> The Applicant, Asphalt Paving Co., represented by� � . <br /> V � MQ496es hereby certify that gx�ymrT' rQF,aak"cc ,...,(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 Ralston Quarry, File Number M- <br /> 1974-086. <br /> 77tis farm has been approved by the Colorado Mined Land Reciantatinn Board purstiant to its authority tnidt r <br /> the Colorado Land Recfantation Act for rite Ertraclion of Construction Materials and the Colorado Mitred Land <br /> Reclamation Act fur Hard Ruck, Metal.,and Designated Mining Operations.Any alteration or ntudifrcation to <br /> this form small result in voiding thus form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant Representative Name�./ , <br /> Date d� f .°Titletf l y , <br /> STATE OF } <br /> ss. <br /> COUNTY 4 � <br /> The foregoing was acknowledged betorc methis sr 2U_day of Y!_I , b. y <br /> 'A"as f' � ,• tt f_� l 1 1C4 <br /> _c. v ?6w. My Commission Expires: �`� �� ��•.� <br /> Notary Public <br /> TERESE VfRGItV! AS RD <br /> Notary f u61ic <br /> Not a rp ID tt 20 t 940594E <br /> M Gammission Expirss 42-1 2-2023 <br />