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Varra 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 we <br />have been 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, as notarized below, we concur that planned activities detailed in the <br />application for permit M-2009-018 do not threaten our qualified significant, valuable and permanent <br />adjacent man-made structures; and that any damage to said structures directly attributed to the <br />activities of Varra Companies, Inc. (the Operator); will be compensated for by the Operator. <br />0a'Z1_ZJ_e_,e _09e?e-?- j??- Z?7- _-2 e9 .2009 <br />Signature of Adjacent Landowner Date <br />Print Name ???a ?? A. <br />p1AR y <br />State of cola a&' ) ;.. <br />\ ,,' ) <br />County of V V Q.?c? ) ss. ; Oz <br />The foregoin instrument was acknowledged before me this day of (41Ae?t <br />0 - , <br />20n09, by a r e l]l Ro-a rsoi'1 ( n noQpy- for <br />1.? (U' [SYl T)CA A r'c ). 'ritle <br />Company or Corpoi ? tio? LL?W__?A <br />Notary Public <br />th <br />My Commission expires: ? (- .QC. 'a(,101 <br />2