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of C�� <br />k8 .COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203 ph(303) 866-3567 <br />187r. <br />REQUEST FOR FULL OR PARTIAL RELEASE OF PERMIT AIR CEIVE® <br />Please indicate if you are requesting: <br />FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA <br />MAY 1 2015 <br />( ) ✓ /rJ DMESION OF RECLAMATION <br />ACREAGE REDUCTION PARTIAL RELEASE r +' I:!20GAW S.AFEW <br />If you are requesting an acreage reduction, you will need to specify 17V p—acres you wish to remove <br />from the existing permit under this revision. I wish to releaseT `% s� 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 />'2002-109 Cucharas Pit <br />File No.: M- Site Name: <br />County: Huerfano <br />�O,Permittee:A. Blasi & Son Trucking & Earthmoving LLC. <br />Operator (If Other than Permittee): <br />Permittee Representative:Anthony Blasi <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 />Jim Pace <br />603 W. Calle De Caballos <br />Pueblo West, CO 81007-1892 <br />719-547-1037 <br />✓ j/iD14 ao66 oaf <br />—_ - M !/ a �i826 <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 />Signature of Perrniitee, Operator or their Authorized agent <br />05/12/2015 <br />Date <br />Important. In accordance with Rule 4.17.1(3)This release request must be submitted to the Division <br />-, y ---,I <br />