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V r , <br /> OF Cp10 <br /> � $ COLORADO DIVISION OF RECLAMATION, MINING 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: &lei tnIItt <br /> FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA OCT 2 � 2015 <br /> ACREAGE REDUCTION (PARTIAL RELEASE) DIVISION OF RECLAMATION <br /> If you are requesting an acreage reduction, you will need to specify how many acres you wisHMINSA NDMETY <br /> from the existing permit under this revision. I wish to release S;Z 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- l ?' 7 Q—Zbl7 Site Name: A rW A, <br /> County: <br /> Permittee: 07-65-10-0 Z—V",1L17-V AR02 <br /> Operator(If Other than Permittee): <br /> Permittee Representative: ZEx <br /> Certified Mail# 70c 9 14110 0000 0689 b7�g <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 /> �P�` A a-� <br /> (zA°« 6e-- 9 6,(� <br /> ✓ Compliance <br /> ✓ NO Violations <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 ac rdance with these Ves and all applicable requirements under the Act." <br /> 7111W-W� 10/Z7_ <br /> Signature of Permittee, Operator or their authorized agent Date <br /> Important: In accordance with Rule 4.17.1(3)This release request must be submitted to the Division <br /> via certified mail and separate from any other correspondence to the Division. <br />