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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 Alined 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 Yo"4,4 CAer->Ty Representative Name) — <br /> Date 3` mil'ZO Z I Tit1eCJp. �Tjo►� vim; ;�-� �v�ol,' coo-or" <br /> STATE OF <br /> )ss. <br /> COUNTY OF v tVv ) <br /> The foregoing was acknowledge befgre me this,q�`day of �(�(� c`1 , 20�\,by <br /> as of <br /> My Commission Expires: - DQ Q�-)- <br /> Notary Public' <br /> NANCY L WRIW <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> (VOTARY ID 19934019442 <br /> w,,commWON EXPIRES APRIL 1,2022 <br />