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CERTIFICATION <br /> The Applicant, Fremont Paving and Redi Mix, Inc. (print applicant/company name), <br /> by John P. Ary (print representative's name),as President (print <br /> representative's title),does hereby certify that Pueblo County (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-1998-038 <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 /> ACKNOWL G i •• <br /> Applicant `i,. ;1 ✓%��•.- :_..-'; Representative Name <br /> Date IN V. I`Q3= -ciod3 Title-4,rE61lt k " <br /> STATE OF ) <br /> )ss. <br /> COUNTY OF-1,4 t-D ) <br /> The oregoin was acknowledged'sre me this 1p day of �,t,,. , .20. - by - , <br /> hes as b1/l�G�-`� °f .1. •. - 14 fZ.� � 1 kt <br /> t <br /> A My Commission Expires: /6/& �G <br /> • <br /> •. Public <br /> JUf�l DA <br /> NC: !BER <br /> RWT�.,2PUBLIC <br /> STATE(JF COLD ADO <br /> P10 Y IDF 20064001792 <br /> MY COMMISSION EXPIRES OCTOBER 6,2026 <br /> Structure Agreement Page 2 of 3 <br />