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`Print Name <br />Varra Companies, Inc. <br />Office of Special Projects <br />8120 Gage Street Frederick, Colorado 80516 Telephone (303) 666 -6657 Fax (303) 666 -6743 <br />• ture of Adjacent Landowner <br />� iiLl�f 4/ <br />State of 00 I C , rao\ 0 <br />County of _he V1 0 F.N' <br />Statement of Understanding <br />Landowner of Adjacent Structure Statement: Our notarized signature below testifies we <br />have been provided with an opportunity to review a Map showing the approximate relationship of our <br />property and the potential for any qualified significant, valuable and permanent man-made structure(s), <br />which may occur within 200 feet of lands affected within the proposed Heintzelman Project (OMLR Permit <br />#: M - 2009 - 018) and is located at or near the E /2,E/2, Section 31; and SW /4,SW /4, Section 28; all in Township <br />3 North, Range 67 West; 6` P.M.; Weld County, Colorado. <br />Upon review of the available materials, including the the Amendment Map showing the planned Conveyor <br />Route within the Amendment application; <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 Project (OMLR Permit #: 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 impact 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 />The foregoing instrument was acknowledged before me this <br />2011 ,by ai �:� } v, :Mnv <br />' F7V\ ex P . l�Ovvn ,I) ni A <br />Company or Corporation <br />.loop!t ly„44 <br />• NoTgpp,•: <br />30. • p= <br />J,'• �°UBLIC. • � , <br />'sion Expiees 3� <br />( 6—°71- c= 3 // ,2011 <br />Date <br />iPtL1/X4a)A>eree e . <br />) ss. <br />(9 5 day of V� <br />.e..)‘(forl <br />_..r.W.111. <br />Notary Public <br />My Commission expires: f 0 <br />l , <br />a,va,o1 <br />2 <br />