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CERTIFICATION <br /> The Applicant, Castle Rock Construction Company of Colorado, LLC (print applicant/company name), <br /> by (print representative's name), as (print <br /> representative's title), does hereby certify that CDOT (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 STOKER BORROW 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 form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT I" " <br /> ACKNOWLEGED BY: YOl <br /> Castle Rock Construction Company of Colorado,LLC <br /> Applicant Representative Name Q r*7 4 <br /> Date 24-j4 j Zo 2Z Title e00 <br /> STATE OF C 0 io"Jo ) <br /> ) ss. <br /> COUNTY OF li�ta a ho ) <br /> The foregoing was acknowledged before me this l`fit day of VA C%Cif f , 20 Z2, by <br /> ft rA y &'00 I <br /> F-J as coo of Castle Rock Construction Company of Colorado,LLC <br /> — My Commission Expires: <br /> Notary Public <br /> DAVID BROOKS <br /> Notary Public <br /> State of Colorado <br /> Notary ID a 20154047623 <br /> My Commission Expires 12-11-2023 <br />