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CERTIFICATION <br /> The Applicant, Arcosa Materials, Inc. by'j y Aam) I/10QUf "L_ T es <br /> hereby certify that American Contract Miners shall hereby be compensated for any damage from the <br /> proposed 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 /> L 0 <br /> Applicant: Representative Name: 1!5v416- <br /> Date Title )T VW4Q "CA— <br /> STATE OF <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this /1'7 day of.�� , 20� by <br /> M vl���� as�lnn� �1 n�nq��of OJT= gy1d'15,, M( ' <br /> a&/)r?qD My Commission Expires:&4w 3 <br /> Notary Public <br /> TW HAMPMN <br /> NOTARY PUBLIC <br /> E <br /> TATE OF COLORADO <br /> TARY ID 20074019521MMISSION E 0WM 02.11.2023 <br />