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CERTIFICATION <br /> The Applicant, GCC RIO GRANDE IINC-(iprint applicant/company name), <br /> by A�Am D "(,0 N (print representative's name), <br /> as--? L W T ANA 6E_K- (print representative's title), <br /> does hereby certify that 6 S Land& Cattle Co. (structure owner) shall be compensated for any damage <br /> from the proposed mining operation to the above listed structure(s) located on or within 200 feet of the <br /> proposed affected area described within Exhibit A, of the Reclamation Permit Application for <br /> Cedarwood Clay Mine (operation name), File Number M-1977-317. <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 GCC RIO GRANDE INC Representative Name An <br /> Date 3 6-" ' 2 2 TitlePLA A-ht^-C,C P, <br /> STATE OF (fo)or4 do ) <br /> ) ss. <br /> COUNTY OF J ) <br /> The foregoing was acknowledged before me this-)&7ay of Y , 2022, by <br /> ALEJANbw ALARCW as PLANT MANAGE`, of <br /> GCC RIO GRANDE INC. <br /> My Commission Expires: f - y-'n Z' <br /> Nota ublic <br /> )ACKI No" <br /> NOTARY PUBLIC•STATE OF COIORADO <br /> Notary ID 40144042744 <br /> my Commission EXOM 11 <br /> V� <br />