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CERTIFICATION <br /> The applicant, Oldcastle SW Group, Inc. , represented by Rich Umbel <br /> as, President does herby certify that Huerfano County(structure owner) shall be <br /> 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 the Reclamation <br /> Permit for Pino Pit , File Number M-2000-118. <br /> This form has been approved by the Colorado Mined Land Reclamation Boardpursuant to its authority under the <br /> Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Mined Land <br /> Reclamation Act for Hard Rock, Metal, and Designated Mining Operations.Any alteration or modification to this <br /> form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: (Signature of Officer) <br /> Applicant Oldcastle SW Group, Inc._Representative Name: Rich Umbel <br /> Date: "I - 1 7 - Title: President <br /> STATE OF !- ) <br /> — )ss. <br /> COUNTY OF 1 o l� ) <br /> The foregoing was acknowledged before me this I"� day of , 20 21, by <br /> das of Dcka"Rv S I l �rrou <br /> o My Commission Expires: HEIDI R. VEACH <br /> Commission Number 1199 <br /> Notary-PublicMy Commission Expires <br /> ow► January 14, 2024 <br />