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CERTIFICATION <br /> The Applicant, City and County of Broomfield _(print applicant/company name), <br /> by Brennan Middleton ____(print representative's name), as Water Resources Manager (print <br /> representative's title), does hereby certify that United Power (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 Heit Pit Resource T_ (operation name), <br /> File Number M-2003-016 <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 Minim 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 ' OttAd__(,,vv-1 of_l ,(6k: tet4Representative Name - - — <br /> Date 1 /t 2-12-3 Title �-)e-�,- <br /> STATE OFr <br /> ss. <br /> COUNTY OF6rfl >a ) <br /> The foregoing was acknowledged befAe <br /> me this day of (AV,,) 20 2� by <br /> ��Yln0.h CYI IP�D� as_ nvr�5%9-ke)et'of C, � <br /> My Commission Expires: !`>✓-,j(tj6 f0 Z )a <br /> Notary Public <br /> E <br /> THERINE HARRIS <br /> OTARY PUBLIC <br /> TE OF COLORADO <br /> RY ID 20214005321 <br /> N EXPIRES FEBRUARY 9,2025 <br />