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C. At/ 15 L)�Kl <br /> *% COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br /> a�s 1313 Sherman Street,Room 215,Denver,Colorado 80203 ph(303)866-3567 <br /> � <br /> REQUEST FOR FULL OR PARTIAL RELEASE OF PERMIT AREA <br /> Please indicate if you are requesting: p <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 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 fromthe current permit area, and the resulting new permit boundary. <br /> File No.: M- .. � o� Site Name:J A a A <br /> County: )— <br /> Permittee: <br /> Operator(If Other than Permittee): <br /> Permittee Representative: Alum C <br /> _ ANINGAND SAF Qt�LAMATION <br /> Certified Mail# 7/)// 17171) 1 13 M <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 <br /> �to/the affected land. Please attach additional sheets. for this information if <br /> �r <br /> ri,(,ia�rd/ Ma Takli� = 11 <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 /> sati red in accordance with these Rules and all applicable requirements unde the Act." <br /> z, ie/&" 3� l <br /> Si�nature of Permitt perato their 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 />