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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 Coors Energy Company (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 /! r �'— --G; Representative Name <br /> Date - 11 U S I 1 e - - - ----- Title I} r`-, < < f ��� ►,Y �a Iis 'ct _r <br /> STATE OF <br /> )ss. <br /> COUNTY OF ,` t V�t r�L, ) <br /> The foregoing was acknowledged before me!rthis day of I , 20 << ,by <br /> as L,rksli l 1dL�r of,a <br /> My Commission Expires:__ <br /> Notary Public <br /> SARAH GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174007757 <br /> MY COMMISSION EXPIRES rCRRUARY 21,202S <br />