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CERTIFICATION <br /> The Applicant, City of Grand Junction (print applicant/company name), <br /> by (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 resrdt in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> t 11 <br /> Applicant�lVY 0S Gyulc � fit-• Representative Name f�r. ?r'c., <br /> Date 60 Title - CA \i. 00(\t.S VI L�L�oy- <br /> STATE OF Cd\or ctdrN ) <br /> ) ss. <br /> COUNTY OF M c IS,e ) <br /> The foregoing was acknowledged before me this jay of �, , 20Q0 by <br /> 1� rc2\\ as \�-cWork_� ��cof C ; k,— at C-1rd..6 At.a�i-:vr . <br /> a W My Commission Expires: <br /> tary Public <br /> JANET HARRELL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20144027406 <br /> My Commission Expires July 11,2022 <br />