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t • <br /> CERTIFICATION <br /> The Applicant, ARS Sand & Gravel Company, LLC (print applicant/company name), <br /> by Derek Garben (print representative's name), as President (print <br /> representative's title), does hereby certify that Mountain View Electric Association,Inc.(structure owner) shall <br /> 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 <br /> Permit Application for Elbert County Pit (operation name), <br /> File Number M-1985 - 129. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority render the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT' APPLICANT <br /> ACKNOWLEGED BY: <br /> ApplicantSao-l,r _u.��4 Lut, Representative Name <br /> Date b 1/0 a f Z.S"- — Title P,m-d - <br /> STATE OF mkomdp ) <br /> )ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of b' 20IS7, by <br /> Q£Jrt 6 G-4 r bm _as )U i(d." off 9 9 ►�k Cxruve l "ur <br /> My Commission Expires: COs•06-JOJS ____ <br /> Notary lic <br /> SAM Mcur44M <br /> NOTARY KJOUC•SUM Of COLORADO <br /> WYrAW 10 2016417377 <br /> MY COMAYSWN OMRLS MAY 6,2028 <br />