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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 <br /> representative's title), does hereby certify that central Colorado water conservancy District(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 _ _ '_ (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 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 V( (oo' epresentative Name <br /> Date --ems 123 - Title t,vuk� 1�Csp�i�t3 01\ , �✓ <br /> -- - ------ --------- -------------- -- - --,,,,c --- ------ <br /> STATE OF C lU f A d a ) <br /> ) ss. <br /> COUNTY OFgrovw�e lj ) <br /> The foregoing was aacck`n-owledged before me this IZ day of ►� A( 20 2 by <br /> �c�rnan-,44 dJ 1 -n� as p o � rMgnacgr of C' ('o o m -el� <br /> _ My Commission Expires:, <br /> Notary Public <br /> CATHERINE HARRIS <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20214005321 <br /> MY COMMISSION EXPIRES FEBRUARY 9,2025 <br />