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CERTIFICATION <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 Pinnacle Towers LLC (structure owner) shall <br /> (Parent Company Crown Castle International Corp) <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 E.rtraction 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 FOIL PF.RNI1T APPI.ICANT <br /> ACKNOWLEGED BY: %�+ ��•� <br /> Applicant Black Mountain Sand Weld LLC Representative Name Rhett Bennett <br /> Date 9/5/2019 Title CEO <br /> STATE OF TEXAS ) <br /> ) ss. <br /> COUNTY OF TARRANT ) <br /> The fore oing was acknowledged before me this A day of�eip j ems, 20�, by <br /> as V(,t)�qnj ps M i G o f *10Ak ixIvlA-114_ <br /> W"^' My Commission Expires:Q'���` r�o <br /> Notary Public <br /> �--�----per <br /> 4Mr ate•. <br /> ;?•• r••.. SARAN BAILEY <br /> My Notary ID#130547201 <br /> r' <br /> Expires Febnjary 19,2020 <br />