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CERTIFICATION <br /> The Applicant, Concrete Express, Inc., by Joseph 0' Dea, as General Manager, does hereby <br /> certify that Adams County shall be compensated for any damage from the mining operation to <br /> the 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 Brighton Mine, File Number M-1977- <br /> 436. <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 Concrete Express, Inc. Representative Name(Signature <br /> Date /i <br /> /L- 12..I _ Title Chief Executive Officer <br /> STATE O Colorado ____) <br /> ` )ss. <br /> COUNTY OF. l3-e1 ) <br /> The foregoing was acknowledged before me this /G day of JeU !I ,20 26 , by <br /> Joseph 0'Dea as Chief Executive Officer of Concrete Express, Inc. <br /> __.e.6(,/,& ° ___- <br /> My Commission Expires: of -ZS- ?O2 w <br /> Notary Public <br /> DUSTIN M HARPER <br /> Notary Public <br /> NOTARY FOR STRUCTURE OWNER State of Colorado <br /> Notary ID#20224033250 <br /> My Commission Expires 08-25-2026 <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 />