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'TION, MINING AND SAFETY <br />COLORADO DjyjSION OF RECLAMA Sb6-3567 <br />`�� 1313 Sherman Street, Room 215, <br />Denver, Colorado 802Q3 ph 303 <br />Please indicate if you are requesting: <br />FULIJFNAL RELEASE OF ENTIRE PERMITTED AREA <br />ACREAGE REDUCTION (PARTIAL RELEASE) <br />If you are requesting an acreage reduction, you will neK.L pmany acres v acwrets at his time. <br />from the existing permit under this revision.l wish to release plan ma s that accurately depict both the <br />You will also need to submit updated mining and reclamation p p new rmit boundary <br />proposed acreage to be released from the current permit area and the resulting Pe <br />3 1 <br />File No.: /M_- <br />Site Name' ' <br />CountS:A <br />Permittee: <br />Operator (If Other than permittee): 1 <br />permittee <br />Certified Flail# hone numbers <br />In accordance with Rule 4.17.1(2) the Operator shall include the names, addresses and p <br />of all owners of record to the affected land. Please attach additional sheets four h�� information if <br />required. <br />operator or their agent MUST sign that they have complied with <br />In accordance with Rule 4.17.1(4) the Opthe requirements have been <br />the ng statement: applicable <br />and all applicable Reclamation <br />under the Act" <br />tisfied i accordance n <br />��d�C�� to _ <br />Si tore of Permlitee, Operator or their authorized agent 11�a <br />_. t_ ....'%MWhtPd to the Db!W <br />ZZ•d 8809-ZV8-OL6 Oil 06UB40XEI NootsaAIJ d6£:tio 9 L 9 L Inr <br />