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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 CenturyLink (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 -12g <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under 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 /> Applicant ARS S.,-�y ( � ,LLLRepresentative Name�� <br /> Date_ ()q to $1 Z 5 Title P rtm <br /> STATE OF Cobb& ) <br /> )ss. <br /> COUNTY OF ZeffLfr6M ) <br /> The foregoing was acknowledged before me this 8 day of P , 20 aS, by <br /> My Commission Expires: VS OCQ d1U�$ <br /> NotaryVj blic <br /> SAGE MCLFJ4RE <br /> NOTARY PUBLIC•STATE OF COLOMW <br /> NOTARY ID 20164017977 <br /> MY COMMISSION EXPIRES MAY 6,2028 <br />