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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_Scott & Shelia Brennise (4B Land & Livestock <br /> LLC)_(structure owner) shall be compensated for any damage from the proposed mining <br /> operation to the above listed structure(s) located on or within 200 feet of the proposed affected <br /> area described within Exhibit A, of the Reclamation Permit Application for Breeze Basin <br /> Sand & Gravel, File 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 Group,Inc.dba united Companies Representative Name PP—eterSie and <br /> Date Title Assistant Secreta <br /> STATE OF_Colorado _) SONA L.VAN HORN <br /> ss. NOTARY PUBLIC <br /> STATE OF COLORADO <br /> COUNTY OF Mesa ) NOTARY ID#20144015627 <br /> My Commission Expires April 10,2022 <br /> The foregoing was acknowledged before me thisolay of s j�, , 20 /q, by <br /> as of 0 <br /> My Commission Expires: czne�'Z <br /> Notary Public <br />