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CERTIFICATION <br /> The Applicant. Salisbury Gladstone LLC <br /> Pp _ _ _(print applicanticompany name), <br /> by,Jeff A. Carter (print representative's name). as Manager (print <br /> representative's title),does hereby certify that XCei Energy _(structure owner)shall <br /> be compensate 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 Gladstone Toll Mill (operation name). <br /> File Number M 2020-030 <br /> This form has been approved by the Colorado alined Land Reclamation Board pursuant to itc <br /> authority under the Colorado Land Reclamation Act for the 11vtraction of Construction.Materials and <br /> the Colorado )lined Land Reclamation Acr jor!lard Rock, .Metal, and Designated.fining Operations. <br /> Attu•alteration or modification to this form %hall rr%ult in raiding this form, <br /> \OI \Ill 1-OR 11E10111 \11111 1( \\1 <br /> AC KNOWLEGED BY: <br /> Applicant Sec' i 5bS2/4 14� LARepresentativc Name C C%r�i <br /> Date Title NAA\NJG <br /> STATE OF QOLV.dG`Cj ) <br /> )ss. <br /> COUNTY OFF\\? <br /> The fo going w acknowledged before me this Ely of�s ,2071 ,by <br /> as JAA4ag/_,r of_P' Jr�( <br /> l <br /> My Commission Expires: L 1 <br /> Notary Public <br /> ANNA ROOFbGUU <br /> NOTARY PUBLIC <br /> STATE Of COIORADO <br /> NOTARY 0 20164023e94 <br /> MY COMMMION EXPIRES JUNE t.2022 <br />