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CERTIFICATION <br /> The Applicant,Asphalt Specialties, Co..Inc.,by Daniel W.Hunt,as President,does hereby certify <br /> that Denver Water shall be compensated for any damage from the proposed mining operation to <br /> the above listed structure(s) located on or within 200 feet of the proposed affected area described <br /> within Exhibit A, of the Reclamation Permit Application for Chavers Mining Resource, File <br /> Number M-2015-030. <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 <br /> Materials and the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and <br /> Designated Mining Operations. Any alteration or modification to this form shall result in <br /> voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant Representative Name iG( W. N <br /> Date /(/odeMbeyz- 1 Title PAie,5 'Je-n4- <br /> STATE OF ) <br /> )ss. <br /> COUNTY OF ,-?. ) <br /> The foregoing was acknowledged before me this day of ,20`, by <br /> as , of Lr i t <br /> r <br /> My Commission Expires: <br /> Notary Public <br /> JAN NELSON <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY to I099403WZ7 <br /> My Cwm*sM Expims ApFN 29.2024 <br />