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CERTIFICATION <br /> 1 1 a <br /> The Applicant, l*. L_4nLr� ;, :- 111r1i11 appli,:mIl C; )11.11xtm 1lallic). <br /> bL 1 (print representative's name), a, r�s, k, � (print <br /> representative's title), does hereby certify that (structure owner)shall <br /> �j <br /> be compensated for any damage from the proposed training operation to the above listed structures) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A. of the Reclamation <br /> f / <br /> Permit Application for ;� G Sys (operation name), <br /> File Number M- <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Lund Reclamation Act far the Extraction of Construction Materials and <br /> the Colorado Mined land Reclamation Act for Hard Rock,Metal, and Designates!Mining Operations. <br /> Anj,alteration or modification to this form shall result in voiding this form, <br /> NOTARY FOR 11"E tMIT APPI,WANT <br /> ACKNObb'LEGED BY: 1 <br /> Applicant 14 � Representative Name f>!;_�f <br /> n r <br /> Date - 2 C, Title <br /> STATE OF r <br /> t, p <br /> } S.S. <br /> COUNTY OF <br /> t <br /> The fOreuvini1 wati acknowledged before me this day of 20 Zl . by <br /> +: as — of ' <br /> My Commission Expires: -� �i 4- 1 <br /> Notary Public <br /> SHARON KAYETURNER <br /> Notary Public-State of Colorado <br /> Notary ID 20174016484 <br /> My Commission Expires Apr 17,2021 <br />