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CERTIFICATION <br /> The Applicant, Premium Pellets, LLC (print applicant/company name), <br /> by Ron Petersonj1*xrt%l int representative's name), as rA Q,t IPAY 3 (print <br /> representative's title),does hereby certify that Bent 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 McClave Ranch Pit (operation name), <br /> File Number M- - <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: p <br /> Applicant�(,A-AO Representative Name k �L <br /> Date p -) q ^ 2/ Title 1W4,Mlatr-b <br /> STATE OF Njp,,j,, 1 <br /> ) ss. <br /> COUNTY OF-Prrl Wty3 ) <br /> The foregoing was acknowledged before me this o1} day of juVN '10 a by <br /> 4 1y-MxA l?A'M ` %-2t j .% as Yn e VAbtAs —— of -kM;,&Vh IPt il'a5 t,,LC. <br /> My Commission Expires: /(e <br /> to u is <br /> =6, <br /> E161=R <br /> BLIC <br /> ORADO <br /> 64001792 <br /> MY C OCTOSER 6,2026 <br />