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CERTIFICATION <br /> The Applicant, Arcosa Materials, Inc. by'j U A2-c'V1�0Iuf L T des <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 /> Applicant: Representative Name: <br /> Date Title R46111.m W4 0 STATE OF <br /> OF <br /> ss. <br /> COUNTY OFsr� �L) <br /> The foregoing was acknowledged before me thisoday ofAA16- � , 20JI, by <br /> S � ILfa �PPn as Q n1 N,!!nQjgAj- - "1.4-Yl13 <br /> -Mrs er►r��S, T(JL_. <br /> My Commission Expires: <br /> Notary Public <br /> MA HAMPTON <br /> NOTARY PUWC <br /> STATE OF COLORADO <br /> NOTARY ID 20074019621 <br /> ti1Y COMM"EXPIRES 02.11.2023 <br />