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CERTIFICATION <br /> Thepplicant, United Companies, Inc. (print applicant/company name), <br /> by_L�f Sgorwl (print representative's name),as V S -e .Jer-- - (print <br /> representative's title),does hereby certify that CK+9 6 'p tructure owner)shall <br /> be compensated for any damage from the proposed mining operation too 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 M419" 69. <br /> This fora: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 /> ACKNOWL"E/GED BY: <br /> Applicant (//�/�rc>'� �sr�ieS. Representative Names <br /> Date Al "3- / Title Vi 9 If f 5'7( 51(, . <br /> STATE OF l d IC reR G ) <br /> )ss. <br /> COUNTY OF IV f ) ` <br /> i <br /> The oregoing was acknowledged before me this3✓ day of k-dq-eV ,20 by <br /> A4 as V,A of 11g,Y621 .o"li4 % < <br /> cl�'! My Commission Expires:_ <br /> Notary Public <br /> i <br /> I <br /> GENEVIEVE MARIE BLECHA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#19914003259 <br /> My Can mission Expires April 4,2023 <br />