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* COLORAt(O DIVISION OF RECLAMATION, MINING AND SAFETY <br /> N' <br /> **1876 1313 Sherman Street,Room 215,Denver,Colorado 80203 ph(303)866-3567 <br /> REQUEST FOR FULL OR PARTIAL RELEASE OF PERMIT AREA <br /> Please indicate if you are requesting: <br /> FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA <br /> ACREAGE REDUCTION (PARTIAL RELEASE) <br /> If you are requesting an acreage reduction, you will need to specify how many acres you wish to remove <br /> from the existing permit under this revision. I wish to release W. I acres at this time. <br /> You will also need to submit updated mining and reclamation plan maps that accurately depict both the <br /> proposed acreage to be released from the current permit area, and the resulting new permit boundary. <br /> File No.: M- 2004-026 Site Name: Leone Gravel Pit <br /> county: Las An i mas <br /> Permittee: f_RhA)K <br /> Operator(If Other than lPermittee): <br /> Permittee Representative: <br /> Certified Mail# <br /> In accordance with Rule 4.17.1(2)the Operator shall include the names, addresses and phone numbers <br /> of all owners of record to the affected land. Please attach additional sheets for this information if <br /> required.q z A�y2z� t � RECEIVED <br /> I- J19-Y12 r -ea JUL 10 2014 <br /> ama , <br /> Mining&Safety <br /> cz>1/-/I.�O MA ►IJ s7- <br /> kIt) I A.D (.Z s�!/08� <br /> 7/9- 8�� 4170 <br /> In accordance with Rule 4.17.1(4)the Operator or their agent MUST sign that they have complied with <br /> the following statement: "All applicable portions of the Reclamation Plan requirements have been <br /> satisfied in accordance with these Rules and all applicable requirements under the Act." <br /> J_Q�, 1, — r/- � - <br /> Signature of Permittee, O ator or the authorized agent Date <br /> Important. In accordance with Rule 4.17.1(3)This release request must be submitted to the Division <br /> via certified mail and separate from any other correspondence to the Division. <br />