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CERTIFICATION <br /> The Applicant, United Companies, Inc. (print applicant/company name), <br /> by I (print representative's name),as Ve f Ss,t- Sec (print <br /> r <br /> representative's title),does hereby certify that be r Nx (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 Otter Creek Pit expansion _ (operation name), <br /> File Number M-Al; 60 <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 /> ACKNOWLE/GED BY: <br /> Applicant y4IV f r' Q* ,405, ,IirC . Representative Name /e&rr ✓. .5/e't3rr vor✓ <br /> Date /O - 3 -/ 9 Title �/'� ft�st $CC. <br /> STATE OF62� �) <br /> ss. <br /> COUNTY OF ) <br /> The fore ehis �dayof UfG (- 20/�,by <br /> jpQMUAd as V. 4 of t i i TN C__- <br /> v4W.zly-GY Alat My Commission Expires: /• y <br /> Notary Public <br /> GENEVIEVE MARIE BLECHA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#19914003259 <br /> My Commission Expires April 4,2023 <br />