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CERTIFICATION <br /> The Applicant, Arcosa Materials, Inc. i5roAgC4 9 ��k - ,&4)41KZ , 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 E.Wraction 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 fornn. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOW <br /> APPlicant- Representative <br /> resentative Name. i AcZT <br /> Date _ <br /> STATE OF ) <br /> ss. <br /> COUNTY OF ) <br /> The foregoin was acknowledged before me this2day of 20 , by <br /> t��1� `lam as 'P1(kt`tt MA()tea of S <br /> My Commission Expires:CZ/ <br /> Notary Public <br /> µ TW HAMPTON <br /> NOTARY PUBLIC <br /> STATE OF COLORPZO <br /> NOTARY ID 20074019521 <br /> �'COIAMISSIION EXPIRES 02.11.2023 <br />