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• <br /> CERTIFICATION <br /> The Applicant, Amrize West Central Inc., by Travis Smith, as General Manager, does hereby <br /> certify that Black Hills Energy shall be compensated for any damage from the mining operation <br /> to the above listed structure(s) located on or within 200 feet of the proposed affected area <br /> described within Exhibit A, of the Reclamation Permit Application for T.H.E. Aggregate Source, <br /> 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: <br /> Applicant Alst Central Inc, Representative Name: <br /> Date i/a S Title:General Man - <br /> STATE OF Colorado j <br /> )ss. <br /> COUNTY OF Jefferson ) <br /> The foregoing was acknowledged before me this g day of C)is w1 r, 2OZ<by <br /> Tr Smith as Gene TI Manager of Amrize West Central Inc, <br /> 1GLIV \,'• My Commission Expires: c? /-.)) i /4'! <br /> Notary Public <br /> SARAH GREGA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174007757 VOTARY FOR STRUCTURE OWNER <br /> MY COMMI$ IQN 3NRES FEBRUARY 21,2029 <br /> ACKNOWLEGED BY: / <br /> Structure Owner(signature) % ---� Name: ip4m 'TR- V12 o <br /> Date: 9l2 V/Z .S- Title: E/e cf'-c o?s Mf,•or,s /Ljt.,1.49.r,- <br /> , /_ (3/'a c% /-,ii//S 67 he,'" , C 0/.n{/. F tt c-�..,'( <br /> STATE OF c)G(/te / <br /> /? � / )ss. <br /> COUNTY OF 1�,f�G j) <br /> The) going was acknowledged before me this. day of k�i<ley, 20 o2$by <br /> i ) A=„ % -as Si �c L,j i j iish 4 f e4 / . ,s <br /> 5 <br /> _ My Commission Expires:_ A/,7(JL <br /> Nota ublic <br /> 2/2 <br /> ..w,i-M..l...N...m.Ac..a0..tti,.a...® <br /> OLGASONNENBURG I <br /> NOTARY PUBLIC-STATE OF COLORADO <br /> NOTARY ID 20204032681 <br /> MY COMMISSION EXPIRES SEP 18, 2028 0 <br />