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CERTIFICATION <br /> The Applicant, Oldcastle SW Group, Inc. dba United Companies,by Pete Siegmund, as <br /> Assistant Secretary,does hereby certify that_CenturyLink_(structure owner) shall be <br /> 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 <br /> Exhibit A,of the Reclamation Permit Application for Breeze Basin Sand & Gravel, File <br /> Number M2008-022 <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority under <br /> the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Mined Land <br /> Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. Any alteration or modification to <br /> this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant oldcastle sw Groun.Inc.dha United companies_Representative Name_Peter i.Siegmund _ <br /> Date Title Assistant Sec[gLary <br /> STATE OF_Colorado _) SONA L.VAN HORN <br /> SS. NOTARY PUBLIC <br /> STATE OF COLORADO <br /> COUNTY OF Mesa ) MY� �,2022 <br /> The foregoing was acknowledged before me this A9'day of �' ,,� ,20_A,by <br /> a <br /> � c-- of t�Ck� `S � • <br /> —�-� s 5..�- rout C <br /> My Commission Expires: <br /> Notary Public <br /> I <br />