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CERTIFICATION <br /> The Applicant, Ccx.oRAbo CALvrn -r Co G . (print applicant/company name), <br /> by 13R4 A►J K. Lees (print representative's name), as l>2 E s rt,E a rg' (print <br /> representative's title), does hereby certify that "rile -TO wl Dff ALMA (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 "stE-rao t T C t c'- f tNP. (operation name), <br /> File Number M-2o II-oo3. <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 /> ACKNOWLEGED BY: <br /> Applicant Caton n RAbv CALV m 61. Co, =a a, Representative Name "g R./A rJ l< . L r e.s <br /> Date .Z L3vA2`-t T z.o Lm Title asroekTr <br /> STATE OF Coloraio ) <br /> ) ss. <br /> COUNTY OF Jefferson ) <br /> The foregoing was acknowledged before me this 7 day of 0-Rriwry ,20.1O, by <br /> 13 cyan <. Lees as eres,deo+ of CaloraJo Calumet Co, Inc. . <br /> 6.204-.1. )141,04-, My Commission Expires: My I I f 0 a <br /> Notary Public <br /> EI NOTAR �EN <br /> STATE OF COLORADO <br /> � <br /> MIRES MAY 1 <br /> MY11,21122 <br />