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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 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 IIeintzelman 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 />Signature of Adjacent Landowner <br />/f - 6 `, .2009 <br />Date <br />Print Name <br />State of 6LLA&1V ) <br />ss. <br />County of <br />The foregoing instrument was acknowledged before me this OJ?N <br />day of AA1'? f , <br />2009, by D>eg tS E t £L_ T ( V, -W rga.-d e. j- for <br />L -Er, EVext.S7-, r?IC . ). Title <br />Company or Corporation <br />LYNN MAYER SHULTS <br />Notary 1 blic p <br />My Commission expires: 0 l '-DO -Z-10y <br />?TE OR COLORADO 2