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CERTIFICATION <br /> The Applicant, Arcosa Materials, Inc. by -ugfQ-�- �r`� c(,tf 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 carder 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 10 this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGE <br /> Applicant: Representative Name:-:!�70Q(&- 1—:-Cd <br /> Date Title�A-iV-�(_�,4�J �/� <br /> STATE OFLQ_) <br /> ss. <br /> COUNTY OFj&,M ) <br /> -['he foregoing was acknowledged before me this( day of , 20�, by <br /> �(3 ��Ur'p.r1 as- � nK�—of <br /> My Commission Expires: 6o2�//1o;?z2d,3 <br /> Notary Public <br /> TIA NAMPTON <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20074019521 <br /> PAY COMMISSION EXPIRES 02-11.2023 <br />