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1 <br /> CERTIFICATION <br /> The Applicant, Amrize West Central Inc., by Kevin Peart, as Senior Vice President, does hereby <br /> certify that Public Service Company of Colorado shall be compensated for any damage from the <br /> mining operation to the above listed structure(s) located on or within 200 feet of the proposed <br /> affected area described within Exhibit A, of the Reclamation Permit Application for Irwin./Thomas <br /> Mine, 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 <br /> , 4`-'0,\.iApplicant / 1-44, 1.4 (WPM J . Representative Name <br /> Date $ i• 5 l S Title S d i9 M ouy--nh-I N (?4(o(o t) <br /> STATE OF r()(1.5 att u ) <br /> )ss. <br /> J <br /> COUNTY OF e ,g ) <br /> Ttie foregoing was acknowledged before me this 35 day of A, ( i5-I , 2035, by <br /> V I r> Perky • as S1)r of ri LP UI3Qht GLnrrat Ire . <br /> (/Ac,k L,, My Commission Expires: D JJ I '3e1 <br /> No .. ' <br /> SARAH GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174007757 •TARY FOR STRUCTURE OWNER <br /> MY COMMISSION EXPIRES FEBRUARY 21,20 <br /> AC' 'OWLEGED 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 />