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C-131A4 .Lt^//Cs <br /> Certification <br /> The Applicant, ARS Sand& Gravel Co, LLC (print applicant/company name),by Derek Garben(print <br /> representative's name), as President(print representative's title),does hereby certify that Elbert County(structure <br /> owner) shall 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 Permit <br /> Application for Elbert Sand& Gravel Pit(operation name), File Number M-1985-129. <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 <br /> Materials and the Colorado Mined Land Reclamation Act for Hard Rock,Metal, and <br /> Designated Mining Operations. Any alteration or modification to this form shall result in <br /> voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Applicant likI 5� � 4�,,,,,,,t,� Co, LI-t. Representative Name 7/(/1--- <br /> Date 07/1.t f'Lc Title ��t,�.�c.•.� <br /> STATE OF Cc lcrjap ) <br /> ) ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this ` day of 1 .t-Qq v� A , 202S by <br /> �Q,I o lc a-ta.Y fN as pYf-B�Clr'fbi VV of Q.6 &i /28lrave./ &hp ky1 <br /> My commission Expires: C •0(p -ca0 3 <br /> Notary Public <br /> SAGE MCLEMORE <br /> I NOTARY PUBLIC-STATE OF COLORADO <br /> NOTARY ID 20164017577 <br /> I MY COMMISSION EXPIRES MAY 6,2028 <br />