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__......_.._-___--__ -- <br /> CERTIFICATION <br /> � I <br /> j 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_oWogk sw Groun.Inc.dba Vnited comp*io Representative Name Peter 1 Siegmund <br /> Date Title Assistant Secretary <br /> STATE OF—Colorado ,) SMA L.VAN HORN <br /> )ss. STATE E O CuTARY 1p IC <br /> COUNTY OF mesa ) MYNCW EVMAPtl1oOTARY 10 22022 <br /> The foregoing was acknowledged before me this,99 4'day of S�N;� 20.1�. by <br /> as Cam. ZA—cr- of 6'Aadp�" ���1.Qt�O o . <br /> Vr <br /> Vt4A My Commission Expires:, <br /> Notary Public <br />