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CERTIFICATION <br /> The Applicant, Aggregate Industries -WCR, Inc. (print applicant/company name), <br /> by W. Chance Allen (print representative's name),as Regional General Manager (print <br /> representative's title),does hereby certify that The Crabb Trust (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 Wattenberg Disturbance Reclamation (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 <br /> ACKNOWLEGED BY: <br /> Applicant Representative Name <br /> Date t`' �, - -- Title iit ( C i u r tiG �C(f tii. � <br /> STATE OF �', 1,, (&�j ) <br /> ) ss. <br /> COUNTY OF_L, - <br /> The foregoing was acknowledged before me this I` day of 20_�, by <br /> asiIi of 1: ;rl•�,. s;Y < t t" Ir Irk <br /> c ` <br /> My Commission Expires: I L_ <br /> Notary Public <br /> SARAH GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174007757 <br /> MY COMMISSION EXPIRES FE6RUARV 21,21125 <br />