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CERTIFICATION <br /> The Applicant, Y4pi 4. rte,un41 (print applicant/company name), <br /> by a/#. d et So (print representative's name), as Rock &l ,. £,�,,ue. s# (print <br /> representative's title), does hereby certify that Lair,t,e I a- (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 p,4.4.1‘,7 ICGG (operation name), <br /> File Number M3-es7. <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 Yun &. Caws Representative Named-��� — <br /> Date oa,41// & y Title R 64 Q r cal, Si, <br /> pc rvt•so <br /> STATE OF C(j[Ulr a ) <br /> ) ss. <br /> COUNTY OF \I ) <br /> The fore.oing was acknowledged before me this a I day of r�), Y, , 20 0,&), by <br /> .. . e.. as -0LJ \hSo r of 4ulufLeduckarizifriclyx <br /> My Commission Expires: ((L 2/5,_4(2 <br /> Notary rblic <br /> KIMBERLY GAUL <br /> NOTARY PUBLIC•STATE OF COLORADO <br /> Notary ID#20224010584 <br /> My Commission Expires 3/1612026 <br />