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CERTIFICATION <br /> The Applicant, Martinez Western Constructors Inc. <br /> By Paul Martinez <br /> As Vice President, does hereby certify that Mesa County, (structure owner) shall <br /> be compensated for any damage from the proposed mining operation to the above listed <br /> structure(s) located on or within 200 feet of the proposed affected area described within Exhibit <br /> A, of the Reclamation <br /> Permit Application for Ducray Pit (operation name), <br /> File Number M-2018-018. <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 <br /> Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining <br /> Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOW <br /> A plicant Representative Name <br /> Z- -. p <br /> Date Zblicl Title �/ <br /> STATE OF <br /> ) ss. <br /> COUNTY OF I-riay ) <br /> The foregoing was acknowledged beforer�- <br /> e this day of , 2 , b <br /> � b g r g <br /> as D ,ej v Of D�f+ 1►�C2 `l_)ci t,�1� l�;►�S 1L L�ov S <br /> My Commission Expires: <br /> Notary Public <br /> ANNE DUSTIN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20044009724 <br /> My Commission Expires March 18,2020 <br />