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1 <br /> CERTIFICATION <br /> The Applicant, Amrize West Central Inc., by Travis Smith, as General Manager, does hereby <br /> certify that the City of Canon City shall be compensated for any damage from the mining <br /> operation to the above listed structure(s) located on or within 200 feet of the proposed affected <br /> area described within Exhibit A, of the Reclamation Permit Application for T.H.E. Aggregate <br /> Source, M-1977-193. <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: —1 <br /> Applicant Amrize West Central Inc. Representative Nam • <br /> Date /q/7`i Title: General Ma clr <br /> STATE OF Colorado ) <br /> )ss. <br /> COUNTY OF Jefferson )The foregoing was acknowledged before me this 9 <br /> day of a",YYI ba , 202Sby <br /> Tr vi�Smith as Gener4Manacier of Amrize West Central Inc. <br /> 71 <br /> I L ,1. My Commission Expires: <br /> b 11Qd1 <br /> Notary Public <br /> SARAH GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO 'VOTARY FOR STRUCTURE OWNER <br /> NOTARY ID 20174007757 <br /> AdYatt$Saga8ES FEBRUARY 21,2029 <br /> Structure Owner(signature) / ,ir Name: i "4 4 37 e[Ie/1 t <br /> Date: I-aa-aO'a.5 Title: CI‘-.( ircKiNxiNtSEca}rn- <br /> STATE OF Colocodo ) <br /> )ss. <br /> COUNTY OF PCf.A10(\• ) <br /> The foregoing was acknowledged before me thisigatt day of '5€PFFembei , 2016 by <br /> Ryan 51-e-Ve n5 as Ci 4 Qdmiftcsl-ro-ior of Co-no r el\- <br /> Chtti9t, My Commission Expires: v Il-I c'1-1031 <br /> Notary Public <br /> ALLISON ROSE APPLEMAN <br /> NOTARY PUBLIC 2/2 <br /> STATE OF COLORADO <br /> NOTARY ID 20234014863 <br /> MY COMMISSION EXPIRES APRIL 19,2027 <br />