2023-02-27_PERMIT FILE - M2023006

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Structure Agreement This letter has been provided to you as the owner of a structure on or within two hundred(200)feet of a proposed mine site,the Kelly's Pond Project.The State of Colorado,Division of Reclamation,Mining and Safety("Division")requires that where a mining operation will adversely affect the stability of any significant,valuable and permanent man-made structure located within two hundred(200)feet of the affected land,the Applicant shall either, a)Provide a notarized agreement between the Applicant and the Person(s)having an interest in the structure,that the Applicant is to provide compensation for any damage to the structure;or b)Where such an agreement cannot be reached,the Applicant shall provide an appropriate engineering evaluation that demonstrates that such structure shall not be damaged by activities occurring at the mining operation;or c)Where such structure is a utility,the Applicant may supply a notarized letter,on utility letterhead,from the owner(s)of the utility that the mining and reclamation activities,as proposed,will have"no negative effect"on their utility. (Construction Materials Rule 6.3.12 and Rule 6.4.19&Hord Rock/Metal Mining Rule 6.3.12 and Rule 6.4.20)The Colorado Mined Land Reclamation Board("Board")has determined that this form,if properly executed,represents on agreement that complies with Construction Materials Rule 6.3.12(a),Rule 6.4.19(a),and C.R.S.§34-32 5-115(4)(e)and with Hard Rock/Metal Mining Rule 6.3.12(a),Rule 6.4.20(a),and C.R.S §34-32-115(4)(d) This form is for the sole purpose of ensuring compliance with the Rules and Regulations and shall not make the Board or Division a necessary party to any private civil lawsuit to enforce the terms of the agreement or create any enforcement obligations in the Board or the Division.) The following structures are located on or within 200 feet of the proposed affected area: 1.Outbuildings.driv'eways,utilities,fencing,and other structures on Parcels 595921100002 and 59592 1 1 0001 5 CERTIFICATION The Applicant,Crossfire Aggregate Services LLC,by Perry Neil,as Manager,does hereby certify that Kenneth Pena (structure owner)shall be compensated for any damage from the proposed mining operation to the above listed structure(s)located on or within 200 feet of the proposed affected area described within Exhibit A,of the Reclamation Permit Application for Kelly's Pond Project(operation name), File Number M-2022- This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Mined Land Reclamation Act for Hard Rock,Metal,and Designated Mining Operations.Any alteration or modification to this form shall result In voiding this form. NOTARY FOR PERMIT APPLICANT ACKNOWLEGED BY: -` j.1�?a -1 (Signature) Applicant Crossfire Aggregate Serviceb LLC Representative Name Perry Neil Title Manager STATE OF enZ ► i I ss. COUNTY OF A/ ) The foregoing was acknowledged before me this)day of _Jt.L r16 20,Z?by SEAL Pend Neil as Manager of Crossfire Aggregate Services LLC. _ BERNADETTE YOUNG �� My Commission Expires: M 4�"Z ry STATE F C20� Notary Public r NOTARY STRUCTURE OWNER py� SAtJGU57t3 2022 ACKNOWLEGED BY: (Signature) Structure Owner Kenneth Pena PO BOX 1763 ARBOLES CO 81121 Name Kenneth Pena Title Landowner STATE OF 0.8� _ ► 1 SS. COUNTY OF jLePr�,r I The foregoing was acknowledged before me this day of 311 rip- 20s2A by SEAL Kenneth Pena as Landowner of Parcels 595921100002 and 595921100015 (/1�11 I 1 MARCIA R VINING ,it l)f:Ln� 3 My Commission Expires: '�- Ito- .7w NOTARY PUBLIC-STATE OF COLORADO Notary Public NOTARY ID 20154027712 MY COMMISSION EXPIRES JUL 16, 2023