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COLORADO DIVISION OF RECLAMATION, NIINING 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: <br />FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA JULL / <br />205 <br />ACREAGE REDUCTION (PARTIAL RELEASE)_ <br />ION <br />If you are requesting an acreage reduction, you will need to specify how many acres you wi 3.gWyr- yfrom the existing permit under this revision. I wish to release 2930 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- 1977 -163 -SG Site Name: FISHER PIT <br />county: L I N C O L N <br />Permittee: LINCOLN COUNTY <br />Operator (If Other than Permittee): <br />Permittee Representative: J O H N D E W I TT <br />Certified Mail# 7015 0640 0000 2141 2854 <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 />SHRINER'S HOSPITAL FOR CHILDREN <br />PO BOX 31356 <br />TAMPA, FL 33631-3356 <br />✓ Compliance <br />Aft. TOM GUTHRIE v/ No Violations <br />813-281-0300 <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 />/ _ JULY 24, 2015 <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 certified mail and separate from any other correspondence to the Division. <br />