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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 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 />Al? yze - - 9 l .2009 <br />Signal re of Adjacent Landowner Date <br />•° 14_ eee, 4~ ? <br />Print Name <br />State of to FL6k-(-L ) <br />ss. <br />County of Jl. &-il 1/? ) <br />f? <br />1-11 el foregoin 7 instrument was acknowledged before me this day o <br />c_° 17 &_ r <br />4D 1 <br />2009, by i n L_ for <br />)• Title c <br />Company or C pora ion <br />t b' <br />My Commission expires: z11,2,L1,-'1J0 <br />RECEIVED <br />2 <br />SEP X tS 2009