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CERTIFICATION <br /> The Applicant, Solberg Gravel LLC (print applicant/company name), <br /> by Robert Solberg (print representative's name),as Managing Partner (print <br /> representative's title), does hereby certify that Mountain VM e.,4 Electric A55 ftructure 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 Solberg Pit (operation name), <br /> File Number M-1981.044 . <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 and Rock,Metal, !and-Designated Mining ng C)nerat ops. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> A!"'KNC,��I�IT EfT!E�D l�V �� a <br /> Applican / Representative Namet"�=hc;® O t f' <br /> Date Title .,�.1r <br /> cTATE OF CU�l7'�� ) <br /> ss. <br /> COUNTY OF (%� �mo— ) <br /> Th foregoing as acknowledged before me this day of i'l� , 2by <br /> as 6 of UV <br /> My Commission Expires: <br /> Notary Public <br /> JESSI TUBBS <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174023109 <br /> MY Commission Exoires o6_oi_2n2s <br />