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CERTIFICATION <br /> The Applicant, Fremont Paving & Redi-Mix (print applicant/company name), <br /> by John Paul Ary (print representative's name), as President (print <br /> representative's title), does hereby certify that Gary Fillmore (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 Two Rivers Pit (operation name), <br /> File Number M-M1998-038 <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 <br /> Applicant - Representative Name <br /> Date ,�1 fit, . Title p µ <br /> STATE OF ) <br /> ss. <br /> COUNTY OF . ) <br /> The foregoin was acknowledged fore me this day of I , , 20�.-�;by <br /> My Commission Expires:( r, <br /> Nota lic <br /> JODI D SCHkFIBER <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20064 001792 <br /> Uy COMMISSION EXPIRES OCTOBER 6,2026 <br />