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To: 'DBMS Den Page 10 of 11 2019-04-02 15:59.32(GMT) 13032008630 From: Ben Langenfeld <br /> CERTIhICATIOI`+l <br /> The Applicant, Asphalt Paving Co.,represented by' ,P—� � as <br /> VICE &63 J does hereby certify that � . � � —. (structure <br /> owner)shall be compensated for any damage from the proposed mining operation to the <br /> above listed structure(s) bated 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 /> 77nisform Gas been approved by the Colorado Minted Land Rectamarion Board purstrant to its authority under <br /> the Colorado Land Reclarnrtlor,Act for the Extraction of Construction Materials and the Colorado Minted Larrd <br /> Reclamation Act for hard Rock,Metal, and Designated Mining Operations.Any alteration or modification to <br /> this fornn shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: f%` <br /> 7 <br /> Representative Name <br /> Applicant eres,� �'�. ,,..�.. �`m. ,.. p <br /> IJ <br /> Date <br /> STATE OF tD�, _ ) <br /> Ss <br /> COUNTY OQC(:�-J,�9W) <br /> The foregoing was acknowledged before the thisr_day of„ t„ q.,20, ` m,by <br /> 4Iy Commission Expires <br /> Notary Public <br /> TERESB VIRGINIA LOMBARC) <br /> Notary Public <br /> State of Colorado <br /> Notary 10 4 201 9400SD45 <br /> MY Commission Expires 02-12-2023 <br />