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CERTIFICATION <br /> The Applicant, C'oz.oh'Aao CALUMET C4,, SNL• (print applicant/company name), <br /> by ER AN K. LC-E S (print representative's name), as RCS(1111" (print <br /> representative's title), does hereby certify that SwraT i4o11M I�?4obt z,&. (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 ZE Tito t`v C( TLA t rue• (operation name), <br /> File Number M-ZD 1.7 003 <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 CoLoIZq•ao CALM)GST CD/4g,,Representative Name —SW1A1) /....r.ES <br /> Date zoZo Title si 'vr <br /> STATE OF Cotoro ) <br /> ) ss. <br /> COUNTY OF leffer:oil <br /> The foregoing was acknowledged before me this I o'day of J.n u�r , 20 a 0, by <br /> Bryan Lees as fres;ge„+ of Calor,do C•Ivrnet Co Inc <br /> C,X My Commission Expires: f] y IVA <br /> Notary Public <br /> EILEEN S HANSEN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20064018540 <br /> MY COMMISSION MIRES WY 11,2022 <br />