Laserfiche WebLink
CERTIFICATION <br /> The Applicant, Jalisco International, Inc (print applicant/company name), <br /> by 14( <br /> _-p �- (print representative's name),as PALE p� — (print <br /> representative's title), does hereby certify that MCP Midstream (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 Section 20 Mine (operation name), <br /> File Number M- - <br /> This forme 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 forme. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLr2w <br /> Applicant Representative Name �ekzxt�t <br /> Tate 1 /1 t f 2 16 Title <br /> STATE OF 0,D1 QfQJ V ) <br /> ) ss. <br /> COUNTY OF c ) <br /> The foregoing was acknowledge fore me this tZl Yam-day of 20-a, by <br /> 'ZicYYA asf::,-si rtt rti— of ►` fLxL <br /> 6,A4T-Q )- My Commission Expires: <br /> Notary Public <br /> VANESSA MARGARET EVANS <br /> NOTARY PU13LIIC <br /> STATE OF COLORADO <br /> IMY COMMI3�SITONNEEXPPIRES OCCTOBER 15,2025 <br />