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CERTIFICATION <br /> The Applicant, Arcosa Materials, Inc. by14Q — si��4,(��Q1y�k , does <br /> hereby certify that Mr. John Sainsbury 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 /> ACKNOWLEG <br /> Applicant Representative Named A'4-r Date Title .4 <br /> STATE OF ) <br /> ss. <br /> COUNTY OF ) <br /> � 1 <br /> The foregoin was acknowledged before me thi'���� s, ? day of.�,rC/l , 20/ , by <br /> as ��� nac of����My commission Expires: C�/// <br /> Notary Public <br /> TIA NAMPTON <br /> NOTARL <br /> C <br /> STATE OF ADO <br /> NOTARY ID1V,21 <br /> 1"y COMMISSION 02-11.2023 <br />