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CERTIFICATION <br /> The Applicant, /1 L S*ATE S /7q QjA L S LLC. (print applicant/company name), <br /> by COLE AAMASE (print representative's name), <br /> as_SF.A,Go/e lice itiTsW tTF (print <br /> representative's title), does hereby certify that Jii,v ES ///66OR/' (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 / 2 ar m,ek Ar 7 (operation name), <br /> File Number M-,20X- 0I Z. <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 /> ACKNOWLEG B <br /> .41 <br /> Applicant Representative Name C2Lt AitZERSE,t/ <br /> Date AY /6 /,2021/ Title ,SEAN/oR <br /> STATE OF Vall5aS ) <br /> ) ss. <br /> COUNTY OF spa.v..) ee <br /> The foregoing was acknowledged before me thi5.tiQ day of VY1a►. , 2024,by <br /> 01C IQd/�.PA @v1 as Spr�1Ov �/ of W'S C.OWlpGV/U . <br /> • My Commission Expires: "1 f€ 126 <br /> . r <br /> 'ubh <br /> OPi"Pc, JESSICA L. KITCHEN <br /> NOTARY PUBLIC <br /> STATE, /t <br /> STATE OF KANSAS My Appt Exp25 <br /> ' <br />