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CERTIFICATION <br />The Applicant, RIVERSIDE AGGREGATES, LLC (print applicant/company name), <br />by RUDY TORRES (print representative's name), as OWNER (print <br />representative's title), does hereby certify that Y s D Cn {structure owner) shall <br />be compensated for any damage from the proposed mining operation to the above listed structure(s) <br />located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br />Permit Application for SHARP PIT # 2 (operation name), <br />File Number M- 2013 02$ <br />This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br />authority under the Colorado Land Reclamation Ad for the Extraction of Construction Materials and <br />the Colorado Mined Land Reclamation Act for Hard Rock, Metal; and Designated Mining Operations <br />Any alteration or modification to this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant (ikl>, Representative Name � Y►� <br />Date ,11, j �j Title <br />STATE OF Dyn <br />ss. <br />COUNTY OF ) hh '� n <br />The foregoing was acknowledged before me this day of 9 V \a _ .201-3. by <br />1 UZ <br />My Commission Expires: <br />otaPu Public <br />d <br />4+ <br />i <br />' <br />