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551 C04 C, <br />COLORADO DIVISION OF RECLAMATION, MTNING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203 ph(303) 866-3567 <br />1876 <br />REQUEST FOR FULL OR PARTIAL RELEASE OF PERMIT AREA <br />Please indicate if you are requesting: © RECEIVED <br />FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA 0 <br />�} JUL 15 2015 <br />ACREAGE REDUCTION (PARTIAL RELEASE) <br />need to specify hog many acres you wftdjhr6CLAMATI0N <br />if you are requesting an acreage reduction, y p fY the existin rmit under this revision. 1 wish to releaseacre}RSAFETY <br />fromg Pe <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- l qV-,a go Site Name: it Gt r 1< 1 <br />County: <br />Permittee: <br />Operator (If Other than Permittee): <br />1, <br />Permittee Representative:_�.O4 f O 1n -i <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 />In accordance with Rule 4.17.1(4) the Operator or their agent MUST sign that they have complied with <br />the following statement: "Alt 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 Permittee, Operator or their authorized agent Date <br />7.- with Rule 4.17.1(3)Thls release re ue tt mI <br />-- r/Clxri�l�aylC� <br />ZZ'd 9909-ZtS-OL6 vy Vtd101474 07aBuegOX3N00tsanil d6e:bo 9l 9llnf <br />#w m .0 611 <br />