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CERTIFICATION <br /> The Applicant, Amrize West Central Inc., by Travis Smith, as General Manager, does hereby <br /> certify that Weld County shall be compensated for any damage from the mining operation to the <br /> above listed structure(s) located on or within 200 feet of the proposed affected area described <br /> within Exhibit A, of the Reclamation Permit Application for Riverview Resource, File Number M- <br /> 1999-098. <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 Amrize West Central Inc. Representative Name(Signature)- <br /> Date Sept 2 g / Z S' Title General Manager <br /> STATE OF Colorado ) <br /> )ss. <br /> COUNTY OF Jefferson ) <br /> The foregoing was acknowledged before me this?-3 day of p\e., &v , 202-‘, by <br /> -rpvis Smith as General Manager of Amrize West Central Inc.— <br /> .xl.l_cJ _ —~- My Commission Expires: 0 10 I / 4:1 <br /> Notary Public <br /> SARAH GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO • NOTARY FOR STRUCTURE OWNER <br /> NOTARY ID 20174007757 <br /> MY COMMISSION EXPIRES FEBRUARY 21.2029 <br /> A nrvOvvLhGED BT. <br /> Structure Owner Name(Signature) <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 />