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CERTIFICATION <br /> The Applicant, Arnolds Custom Seeding LLC (print applicant/company name), <br /> by Tyrun Iluwa (piinl iepresentative's name),83 Director (print <br /> representative's title),does hereby certify that Stanley Gingerich (structure owner)shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A,of the <br /> Reclamation Permit Application for Arnold Pit No. 1 (operation name), <br /> File Number M- 2016 022 <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 /> ACKNOWLEDGED BY: <br /> Applicant Arnolds Custom Seeding LLC Representative Name Tyrun Huwa <br /> Date March 27,2019 Title Director <br /> STATE OF ) <br /> 1 -+ i� <br /> )ss. (f <br /> COUNTY OF VJA 0 ) <br /> The foregoing VIA <br /> acknowledged before me this~ day of I�V �C � <br /> � <br /> �V VIA VI �11 J U.)C� as �\f l C��✓ of �t'Y� <br /> 7 C My Commission Expires: `1 1 U 0--3- <br /> tary Public <br /> _ JANiSIE C PEAKE <br /> Notary Public <br /> Stste of Colorado <br /> ldctary ID A 20144016730 <br /> M CcmmissionEx res04.182022 <br />