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CERTIFICATION <br /> The Applicant, Amrize West Central Inc., by Kevin Peart, as Senior Vice President, does hereby <br /> certify that RLSJ Properties LLC shall be compensated for any damage from the mining operation <br /> to the above listed structure(s) located on or within 200 feet of the proposed affected area <br /> described within Exhibit A, of the Reclamation Permit Application for Irwin/Thomas Mine, File <br /> Number M-2016-054. <br /> This form has been approved by the Colorado Mined Land Reclamation Board <br /> pursuant to its authority under the Colorado Land Reclamation Act for the <br /> Extraction of Construction Materials and the Colorado Mined Land Reclamation <br /> Act for Hard Rock, Metal, and Designated Mining Operations. Any alteration or <br /> modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: Ke'39-N <br /> Applicant _Afr.rtizif WL 64,54 �i•� _ Representative Name <br /> Date s/aS as- Title c✓ I<' vt,t u,,Tick vt.r' t2-e 6 cafJ <br /> STATE OF CDW`r C 7 ) <br /> \ � )ss. <br /> COUNTY OF Je t-�C KSc 1� ) <br /> The foregoing was acknowledged before me this day of ausus-1 , 20a5, by <br /> �� j n t'u r as SU f' of Prmr►"14 a'11 C <br /> ,L c�c, My Commission Expires: 3 f 24; <br /> Nota y Put,IL SARAN GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174007757 NOTARY FOR STRUCTURE OWNER <br /> MY COMMISSION EXPIRES FEBRUARY 21,2029 <br /> ACKNOWLEGED BY: <br /> Structure Owner Name <br /> Date Title _ <br /> STATE OF <br /> )ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this day of , 20 , by <br /> as of — — <br /> My Commission Expires: <br /> Notary Public <br /> 2/2 <br />