2015-10-15_REVISION - P2014004

• Permit No: P2014004
• IBM Index Class Name: REVISION
• Doc Date: 10/15/2015
• Doc Name: Request SL01
• From: S. Calhoon/W. Stair
• To: DRMS
• Type & Sequence: SL1
• Email Name: SJM
• Email Name: GRM
• Email Name: WHE
• Media Type: D
• Archive: No

In accordance with Rule 4.17.1(4), if requesting a full or partial acreage release the Operator or their
agent MUST sign that they have complied with the following statement: "All applicable portions of the
Reclamation Plan requirements have been satisfied in accordance with these Rules and all applicable
requirements under the Act."
Signatu er of Permittee, Operator or their authorized agent
09/30/2015
Date
Important.• In accordance with Rules 4.14.2(a) and 4.17.1(3)This release request must be submitted
to the Division via certified mail and separate from any other correspondence to the Division.