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CERTIFICATION <br /> The Applicant, Amrize West Central Inc., by Kevin Peart, as Senior Vice President, does hereby <br /> certify that Boulder County Open Space shall be compensated for any damage from the mining <br /> operation to the above listed structure(s) located on or within 200 feet of the proposed affected <br /> area described within Exhibit A, of the Reclamation Permit Application for Irwin/Thomas Mine, <br /> File 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: <br /> Applicant As., it � h� Representative Name (.6_4_0-1— <br /> Date a 5 as Title SUP Iwo G►"-'TM,uJ t.(-t.-p <br /> STATE OF Po Ycicic.' ) <br /> )ss. <br /> COUNTY OF Se �,k Car.Qn-1 ) <br /> The foregoing kvas acknowledged before me this DC day of prIA.SiAsi , 20 by <br /> lkOtr PPtct as _-_`_.>VF M of Ariz t4)1104 C4.J (etc <br /> t f^ My Commission Expires: J a i I <br /> Notary Public <br /> SARAN GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO NOTARY FOR STRUCTURE OWNER <br /> NOTARY ID 20174007757 <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 />