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CERTIFICATION <br /> The Applicant, Premium Pellets, LLC _ (print applicant/company name), <br /> by Ron Peterson (print representative's name), as (print <br /> representative's title), does hereby certify that Southeast Colorado Power Association(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 Applicant R��9 Representative Name k Ra, Ptc� � <br /> - - <br /> Date 4 `,)-Y(- Z� Title MW ,.j.,4A �'��C✓ <br /> STATE OF--�D1Orn w -__ ) <br /> ) ss. <br /> COUNTY OF n aNVa ) <br /> The foregoing was acknowledged before me this, day of �Ar4 ,20ak,by <br /> rrtU .n �idn�gh as f(verAVjW - of 1prt miu.rrt ,PN.L-ezur. <br /> My Commission Expires: <br /> ai ublic <br /> JODI®SCMFE!BER <br /> NOTARY ir"JS! iC <br /> S- sATr'OF COP r.3RA'DO <br /> h9gTARY ID 20064001792 <br /> MY COMpji33iON F�PIFtt's OCTG5EF\6,2026� <br />