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CERTIFICATION <br /> The Applicant, Arnolds Custom Seeding LLC (print applicant/company name), <br /> by Tyiun Huwa (piiiiL ieNiesentdtive's name),as Director (print <br /> representative's title),does hereby certify that Elaine and Frederick Hepner (structure owner)shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A,of the <br /> Reclamation Permit Application for Arnold Pit No.1 (operation name), <br /> File Number M 201b U22 . <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 /> ACKNOWLEDGED BY: <br /> Applicant Arnolds Custom Seeding LLC Representative Name Tyrun Huwa <br /> Date Marc�nh127,2019 Title Director <br /> STATE <br /> )ss. <br /> COUNTY OF <br /> The foregoin was acknowledged before me thisaa day of`t VA\ by i — — <br /> as ` %' Q of .A N jC ( Ct Z �` 1�'} <br /> C' �"- My Commission Expires: <br /> N tary Public <br /> I, _ E C PEAKE n <br /> dp,3ry Public <br /> cf C31oradc <br /> a y P2014401673G <br /> !J '_ rc•n'iss.on Exj).,as 04.1E-2022 <br />