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Vaffa Companies, Inc. <br />Office of Special Projects <br />8120 Gage Street Frederick, Colorado 80516 Teleyhone (970) 353-8310 Fax (9'70) 353-4047 <br />Statement of Understanding <br />Landowner of Adjacent Structure Statement: Our signature below testifies we have been <br />provided with and opportunity to review <br />1) a Stability Analysis Report pertaining to the proposed Heintzelman Permit Application M- <br />2009-018; 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 Heintzelman Permit Application M-2009- <br />018. <br />Upon review of the included materials; a copy of which will be included along with this Statement of <br />Understanding to the Colorado Division of Reclamation, Mining and Safety; <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 <br />Heintzelman. Permit Application M-2009-018; <br />Further, by our signatures, we concur that planned activities detailed in the application for <br />permit M-2009-018 do not threaten our qualified significant, valuable and permanent adjacent <br />man-made structures. <br />Signature of Adjacent Landowner <br />,20099 <br />Date <br />Print Name <br />2