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CERTIFICATION <br /> The Applicant, YUMA COUNTY (print applicant/company name), <br /> by Don Marr (print representative's name), as Mining Reclamation and Safety Coordinator(print <br /> representative's title),does hereby certify that RLS Ranch LLC (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 Smith Pit (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 fora:shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant__yowl° Representative Name� - <br /> Date :3 "1_?iO Z 1 Title 7-1 Ong <br /> STATE OF ) <br /> )ss. <br /> COUNTY OF q v,M. ) <br /> The foregoing was acknowledge befgre me this,q day of Y�(lC c`1 ,20� ,by <br /> ems, cc,.c� r — <br /> r� '�( T,r -r as �r_ r„c <h.. of <br /> My Commission Expires: - �Q <br /> Notary Public <br /> NANCY L WROW <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 19934019442 <br /> MY COMMISSION EXPIRES APRIL 1,2022 <br />