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CERTIFICATION <br /> The Applicant, Arcosa Materials, Inc. by:�r'yAzg - g<<� ,J W,c te,does <br /> hereby certify that the Hogan Family shall hereby be compensated for any damage from the proposed <br /> mining operations to the above listed structure(s) located on or within the proposed affected areas <br /> described within Exhibit A of the Reclamation Permit Application for Arcosa Lightweight—Boulder <br /> facility, File Number M-1988-108 <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGE <br /> Applicant: Representative Name: Q.(� <br /> Date -1 766 <br /> Title RA&)- - ,4i "Ie <br /> STATE OF D ) <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this( day of , 20�, by <br /> t�(z.rk as�� ll Q��of , <br /> My Commission Expires: <br /> Notary Public <br /> TtA HAMPTON <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20074019521 <br /> MY COMMISSION EXPIRES 02-11.2023 <br />