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CERTIFICATION <br /> The Applicant, Oak Creek Consulting and Production Services, LLC (print applicant/company name), <br /> by Justin Smith (print representative's name), as Manager (print <br /> representative's title), does hereby certify that Mike G. Malone (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 Oak Creek Consulting and Production Services, LLC (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 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 Oak Creek Consulting and Production Services, LLCRepresentative Name Justin Smith <br /> Date April 2021 Title Manager <br /> STATE OF Colorado ) <br /> ss. <br /> COUNTY OF OeAd <br /> The foregoing was acknowledged before me this c&day of April 92021 , by <br /> Justin Smith as Manager of Oak Creek Consultinq and Production Services, LLC. <br /> +ZA�+— My Commission Expires: <br /> Notary Public <br /> AMANDA HILT <br /> NOTARY PUBLIC <br /> State of Colorado <br /> Notary ID#20204002306 <br /> My Commission Expires 1/17/2024 <br />