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('E•:RTIFICATION <br /> The Applicant, Black Mountain Sand Weld LLC (print applicant/company name), <br /> by,Rhett Bennett (print representative's name), as CEO (print <br /> representative's title), does hereby certify that American Tower Asset Sub, LLC(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 Reclamation <br /> Permit Application for Lost Creek Mine (operation name), <br /> File Number M-2018.051 . <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 APPL.IC:4%NT <br /> ACKNOWLEGED BY: A _//� <br /> Applicant Black Mountain Sand Weld l_I.0 Representative Name Rhett Bennett <br /> Date 9/5/2019 Title CEO <br /> STATE OF TEXAS ) <br /> )ss. <br /> COUNTY OF TARRANT ) <br /> The oregoing was acknowledged before me this `0—day of 20 ,by <br /> at as VI _PttbtiC. of TPIVOLVW COLA <br /> My Commission Expires: o (� <br /> No Public U <br /> `s"tr, SARAH BAILEY ;t <br /> My Notary ID 130&i7201 <br /> Expires February 19.2020 <br />