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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) - ' 2 <br /> Date �t Z3 f Z S Title General Manage <br /> STATE OF Colorado <br /> )ss. <br /> COUNTY OF Jefferson )The foregoing was acknowledged before me this 2,3 day of SDp tY , 2025, by <br /> Travis Smith as General Manager of Amrize West Central Inc. <br /> C L(1 My Commission Expires: 2t2l ZCI <br /> N alai y Qu°lit'SARAN GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174007757 NOTARY FOR STRUCTURE OWNER <br /> MY COMMISSION_EXPIRES FEBRUARY 21,2029 <br /> ACKNOWLEGED BY: <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 />