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CERTIFICATION <br /> The Applicant,GCC RIO GRANDE INC (print applicant/company name), <br /> by A LEJ A M b p O ALAPCoO (print representative's name), <br /> as L A,MT M A�1-A-6 E I- (print representative's title), <br /> does hereby certify that The Meadows at Legacy Ranch Landowner's Association, Inc (structure owner) <br /> shall 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 <br /> Reclamation Permit Application for 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 <br /> Date 3 l(o-- 22 Title 6 U P N7 M O'tN A66-R <br /> STATE OF ro ) <br /> )ss. <br /> COUNTY OF eb/u ) <br /> The foregoing was acknowledged before me thiqk <br /> s day of Cl►"C1'1 ,2022,by <br /> ALETA bizo ALAIRCO14 as?LAN-r M ,NA(IeZ of <br /> GCC RIO GRANDE INC. <br /> My Commission Expires: ��' �l—zOZ Z <br /> Notary ublic <br /> )ACKI HONA <br /> NOTARY PUBLIC-STATE OF COLORADO <br /> Notary ID 0201440427" <br /> My Commission Expires 1114r= <br />