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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Release, Acreage Reduction, and Surety Reduction Notices Checklist <br />Site: <br />North Farm Road Pit #1 <br />Permit: <br />M- 1977 -140 � <br />Operator: <br />Mathias Concrete, Inc. <br />Action: <br />Financial Warranty Reduction Request, S_R -_0.1 <br />EPS: <br />Bob Oswald v <br />E ♦ County Commissioners <br />Specify County:_ <br />❑ ♦ Conservation District <br />Specify CD: <br />❑ ♦ Land Owner(s) <br />Name: <br />Address: <br />Rio Grande <br />Rio Grande <br />Thomas Mathias <br />Mathias Concrete, Inc. <br />PO Box 266 <br />Monte Vista, CO 81144 <br />❑ ♦ Water Resources (If there is exposed groundwater) YES_ <br />Instructions: <br />Please send notices of SR -0l request to: County Commissioners, Conservation District, <br />Division of Water Resources, and landowner, as indicated above. <br />Attachments: Application form, Legal description, and Location map are being sent to you as a <br />separate document, to accompany the notices. <br />Thank you — Bob Oswald <br />♦ - Receive one paper copy of Application form, Legal Description and Location Map <br />