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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 Department of Transportation shall be compensated for any damage <br /> from the mining operation to the above listed structure(s) located on or within 200 feet of the <br /> proposed affected area described within Exhibit A, of the Reclamation Permit Application for <br /> Irwin/Thomas 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 tratvo L/ej l sr�' Sr t_ _ Representative Name <br /> Date S I a 5 Title Stir ✓l 0 Iti '1 '�'J 6 t°/ — <br /> STATE OF onto-MD ) <br /> ,n, )ss. <br /> COUNTY OF ,P F-te Kr1"‘ ) <br /> The foregoing v .s acknowledged before me this day of at/VpS-k , 20OS, by <br /> 1 t QIL r k as �;V of 1grv‘r I l S 1 !'„�iti hr a-( l r c <br /> .4O —A— My Commission Expires:_ D 'a I 'a11 <br /> Notary Public <br /> SARAH GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO NOT RY FOR STRUCTURE OWNER <br /> NOTARY ID 20174007757 <br /> ACKNC'A EEWeigivp`RES FEBRt1ARY 21,2029 <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 />