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of cow <br />f� <br />N <br />#x 6 *• <br />ink f6° <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />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 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- -P2 ;�!3'0,2Y Site Name:S /iQf1gr -i -- L-et- C-1 <br />County: C iJ sh::-, t- <br />Operator (If Other than Permittee): <br />nuu V h <br />Permittee Representative: Gomm „t,,,.__ <br />� TIotj <br />Certified Mail# 7/-,'1/ P`tt 7C} <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 />rCY � ' ` `3I �Q 1k � , <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 led in accordance with these Rules and all applicable requirements under the Act." <br />Si nature of Perm itt perato their authorized agent Date <br />Important: In accordance with Rule 4.17.10 This release request must be submitted to the Division <br />via certiTed mail and separate from any other correspondence to the Division. <br />