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To <br />AR01 R45por5e- M1198v�0 <br />°TION, MU dNG AND SAFETY <br />7 DIVISION OF REC�LAMA <br />Fad COLORA�O Dh ,03 86b-3567 <br />V1313 Sherman Street, Room 215, Denier, Colorado 80203 p (' <br />M F In7F. <br />7 1`7 <br />1V E <br />Please indicate if you are requesting: pERMITTED AREA u <br />FULUFINAL RELEASE OF ENTIREJUL 2 0 2015 <br />ACREAGE REDUCTION (PARTIAL RELEASE)t*t, <br />SJ3�YeLAMATION <br />you wilt' need to specify hog man) ` acreYZ <br />cre;t is ict 1>�AFETY <br />ut- <br />if you are requesting an acreage reduction, }` <br />from the existing permit under this revision. I wish to release <br />s t�at <br />you Will also <br />need to submit updated mining and reclamation planheaPesult ng newperm►tpboundary. e <br />proposed acreage to be released from the current Permit are 4 <br />File No.: M-4 <br />Site Name. <br />County: AV,.!C �' <br />Permittee_ <br />Operator (If Other than Permittee): <br />Permittee Representative: 04 <br />Certified Mail# hone numbers <br />in accordance with Rule 4.17.1(2) <br />the Operator shall include the names, addresses and p <br />owners of record to the affected land. Please attach additional sheets for this information i <br />of all l� <br />required. /& n _ : /% /.a V/)/U -,- <br />'? CY /o' <br />,-'?CY/per' <br />with Rule 4.17.1(4) the Operator or their agent MUST sign that they have complied with <br />In accordance wt ltcable onions of the Reclamation Plan requirements have been <br />the ng statement: "All app F requirements under the Act" <br />r ordance with these Rules and all applicable <br />;d 1 acc / /� _ % f <br />Operator or their authorized agent Date <br />tore of Permittee, Ope <br />ZZ'd 011 e6U8g0x3 '�oolseAl-j d6VIVO 9l 9l Inr <br />