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CERTIFICATION <br /> The Applicant, City of Grand Junction (print applicant/company name), <br /> by I rc�� VrG'\ ' (print representative's name), as Public Work Director (print <br /> representative's title), does hereby certify that City of Grand Junction Cemetery(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 Riverside Parkway (operation name), <br /> File Number M-2007-005 . <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(,lVy d� clycrG � cam• Representative Name/ �v(G,_,V rc� ) <br /> Date r✓o a % Zb Title <br /> STATE OF Cc o Y o-c\c') ) <br /> ) ss. <br /> COUNTY OF M c-,e, ) <br /> The foregoing was acknowledged before me this (yay of �, ,,,,� , 20dC� by <br /> as�c�b\�c Wor`�� �cc of ;�., o-d <br /> Lq�Aj,& My Commission Expires: -A - \\ - aQ;��C <br /> 111�tary Public <br /> JANET HARRELL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20144027406 <br /> My Commission Expires July 11,2022 <br />