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The Applicant, <br />ACA Products, Inc. <br />by Blake Bennetts <br />CERTIFICATION <br />(print applicant/company name), <br />(print representative's name), as Sales & Development Manager (print <br />representative's title), does hereby certify that Sangre de Cristo Electric Association, Inc. (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 ACA Products, Inc. <br />File Number M-1979- 010 <br />(operation name), <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 Am �:d�i �'i 5� lw�:-, Representative Name IguwL f��,N•J�T%3 <br />Date Title 5,4Lr 5 Di1/&2s P/4L2V T i&WACc`YL <br />STATE OF r`O& ) <br />ss. <br />COUNTY OF QW4f.) <br />The foregoing was acknowledged before me this Zy day of , 20 ZZ, by <br />as v1' qe of auc�6, =ry-.. <br />My Commission Expires: y latphpe�3 <br />Notary Xblic <br />BETTY CRITES <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY 10: 19954006312 <br />MY COMMISSION EXPIRES: APRIL 26, 2023 <br />