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CERTIFICATION <br /> �r <br /> The A lican As halt S ecialties Co. Inc.by Daniel W. Hunt, as President, does hereby certify <br /> that the '(structure owner)shall be compensated for any damage from the proposed <br /> mining operation to the above listed structure(s) located on or within 200 feet of the proposed <br /> affected area described within Exhibit A, of the Reclamation Permit Application for File number <br /> M 2021 the Stiles Mining Resource. <br /> This form has been approved by the Colorado Mined Land Reclamation Board <br /> pursuant to its authority under the Colorado Land Reclamation Act for the Extraction of <br /> Construction Materials and the Colorado Mined Land Reclamation Act for Hard Rock,Metal, <br /> and Designated Mining Operation&Any alteration or modification to this form shall result in <br /> voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Applicant:Asphalt Specialties Co.,Inc. Representative Name:Daniel W. Hunt <br /> Date: Title: President <br /> STATE OF Colorado ) <br /> )ss. <br /> COUNTY OF Adams <br /> The foregoing was acknowledged before me this day of , 2021,by <br /> Daniel W. Hunt as President of Asphalt Specialties Co. Inc. <br /> My Commission Expires: <br /> Notary Public <br /> H:Tits HBP Plants\EVANS\Stilec Mining Resource\Exh S-Permanent Manmade StmctiureALe ter Structure Agreement Template Stiles.doc <br />