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J <br /> CERTIFICATION <br /> The Ap nt, City of Grand Junction (print applicant/company name), <br /> by 71L. (print representative's name), as Public Works 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-2020-038 . <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 Milted 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 c/-17Y J '`1 �� ep <br /> resentative Name /'G._T� <br /> Date �fz� Title <br /> STATE OF <br /> ss. <br /> COUNTY OF _SG ) <br /> The foregoing was acknowledged before me this_j2 day of , 20 26,by <br /> Src,,,a ? nil as P A)[S1;f ,Iris )irerAbr Of CL-AU00 <br /> My Commission Expires: 2 052 Y <br /> otary blic <br /> HANNA M. COSTANZ]2024 <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 02012404493 <br /> My Commblbn EVIms July 23, <br />