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Varna Companies, Inc. <br /> Office of Special Projects <br /> 8120 Gage Street Frederick, Colorado 80516 Telephone(303)666-6657 Fax(303)666-6743 <br /> Statement of Understanding <br /> Landowner of Adjacent Structure Statement: Our notarized signature below testifies <br /> we have been provided with and opportunity to review: <br /> 1) a Stability Analysis Report pertaining to the proposed Two Rivers Sand, Gravel and Reservoir <br /> Project—Regular Impact(112) Permit Application M-2022-013.;and, <br /> 2) a Map showing the approximate relationship of our property and the potential for any <br /> qualified significant, valuable and permanent man-made structure(s), which may occur <br /> within 200 feet of lands affected within the proposed Two Rivers Sand,Gravel and Reservoir Project— <br /> Regular Impact(112)Permit Application M-2022-013.. <br /> Upon review of the available materials reference here or the attending Public Notice; <br /> And, understanding the relationship of any significant, valuable and permanent man-made structures <br /> under our ownership and which may stand within 200 feet of lands affected within the proposed Two Rivers <br /> Sand,Gravel and Reservoir Project-Regular Impact(112) Permit Application M-2022-013.; <br /> Further, by our signatures, as notarized below, we concur that planned activities detailed in the <br /> application for permit M-2022-013.; do not impact our qualified significant, valuable and permanent <br /> adjacent man-made structures; and to assure you that in the unlikely event damage occurs to such <br /> structures as a direct result of authorized active operations, those damages will be compensated for by <br /> the Operator, consistent with established law. <br /> ,2022 <br /> Signature of Adjacent Landowner Date <br /> Print Name <br /> State of ) <br /> ) ss. <br /> County of ) <br /> The foregoing instrument was acknowledged before me this _day of ,2022, <br /> by ( for <br /> ). Title <br /> Company or Corporation <br /> Notary Public <br /> My Commission expires: <br /> 2 <br />