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,mow •'a- <br /> CERTIFICATION <br /> The applicant, Oldcastle SW Group, Inc. , represented by Rich Umbel <br /> as, President does herby certify that Ed Pino (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: � �o (Signature of Officer) <br /> Applicant (�Oldcastle SW Group, Inc._Representative Name: Rich Umbel <br /> Date: "1 (�- �O� I Title: President <br /> STATE OF ) <br /> �..�.�` I )ss. <br /> COUNTY OF 1 L ) <br /> The foregoing was acknowledged b� e me this I-T day of ��t4 <br /> , 20 21, by <br /> �� 4� ` w. ►�e ( as YES alu,I of 0 v� <br /> HEIDI R. VEACH <br /> 4 F` <br /> l¢t My Commission Expires: _ Commission Number 701199 <br /> NotaryPublic IVWp es <br /> January 14, 2024 <br />