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. 04 COS • �" �/ ���� <br /> MINING AND SAFETY COLORADO DIVISION OF RECLAMATION, <br /> 1876 1313 Sherman Street,Room 215,Denver,Colorado 80203 h 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 //i,/Z 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- /q9 3 - OfD Site Name: ©rl"emcC g" 7- <br /> County: �SO lOuh fit/ <br /> Permittee: ,404+r,c% <br /> Operator(If Other than Permittee): C- <br /> Pennittee Representative: oW-*1-e-C � n— <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. <br /> A, s/L 7- <br /> -7 9 7/9- T TZ- 2-74-/9 <br /> RECEIVED <br /> SEP 2 +4 2014 <br /> h DIVISION OF RECLAMATION <br /> �/)�'- y 2 f ,c0`lj MININGANDSAFETY <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 accord c with these Rules and all applicable requirements under the Act." <br /> 9//9/,y <br /> Signature of Permittee, Operator or 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 />