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The following structures are located on or within 200 feet of the proposed affected area: <br /> 1. Highway 93 roadway surface and roadway embankment <br /> 2. Stormwater drainage swale(s) <br /> 3. Guardrails <br /> 4, Highway signage <br /> CERTIFICAa;ION <br /> The Applicant, Arcosa Materials, Inc. by Stuart McQueen, Plant Manager,does hereby certify that the <br /> Colorado Department of Transportation(CDOT) 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 /> ACKNOWLEGED BY: <br /> Applicant: Arcosa Materials, Inc. Representative Name: Stuart McQueeo"' D' t 13f L, <br /> Date: - 3_ I Title: Plant Manager <br /> STATE OF COLORADO <br /> ss. <br /> COUNTY OF BOULDER ) <br /> The foregoing was acknowledged before me this3day of , 20J3, by <br /> Stuart McQueen as Plant Manager of Arco a Materials,Inc <br /> Ole My Commission Expires: 07/27/2022 <br /> Not Public <br /> CHERYL MELINO <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20184030332 <br /> MY COMMISSION EXPIRES 07/27/2022 <br />