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CERTIFICATION <br /> The Applicant,Southway Construction Company, Inc.of Alamosa,by Alonzo Salazar,as Office <br /> Manager,does hereby certify that Carolina Potts(structure owner)shall be compensated for any <br /> damage from the proposed mining operation to the above listed structure(s) located on or within <br /> 200 feet of the proposed affected area described within Exhibit A, of the Reclamation Permit <br /> Application for the Bradford Mesa Quarry,File Number M-2019-046. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority under the <br /> Colorado Land Reclamation Act for the Fxtraction of Construction Materials and the Colorado Mined Land <br /> Reclamation Act for Hard Rock,Metal,and Designated Mining Operations.Any alteration or mod#lcatlon to this <br /> form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Sokrm W#4q Cv NrrA"04C ,d Co�A+vy ,rwt• o F �►" rA <br /> Applicant Representative Name ALo oj2o r4-c,+4-t,�+�_ <br /> Date &41fi 1 Title F4cc moxotga er <br /> STATE OF Co Io raao ) <br /> ss. <br /> COUNTY OF 01,4wo 4 ) <br /> The foregoing was acknowledged before me this fAday of c+o 6,wr' •20_1?,by <br /> A�,owrt,� $',4c�h2• as ®,APtct to j•r of wrW eb'u cr*4& h o.! Co�rcA.r•uy�. c• <br /> My Commission Expires: <br /> Notary Public <br /> A Y PlUB IC <br /> NOTSTATE OF COLORADO <br />