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a <br /> COLORADO DIVISION OF RECLAMATION MINING AND SAFETY <br /> •r ;* , <br /> „• <br /> 187 1313 Sherman Street,Room 215,Denver,Colorado 80203 ph(303)866-3567 <br /> REQUEST FOR FULL OR PARTIAL RELEASE OF PERIIfN !>�t��ap4 <br /> Please indicate if you are requesting: a FEB 9 201� <br /> FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA <br /> n DIVISION OF RECLAWrIpN <br /> ACREAGE REDUCTION(PARTIAL RELEASE) MININGANDSAFEly <br /> If you are requesting an acreage reduction, you will need to specify how many acres you wish to remove <br /> from the existing permit under this revision. I wish to release 12 6.4 8 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- 1977-081 Site Name: Greeley West Site <br /> County: Weld Aft-, <br /> 1r -03 <br /> Permittee: City of Greeley '_Complied! <br /> ✓0 H1olations <br /> Operator(If Other than Permittee): <br /> Permittee Representative:Burt Knight, City of Greeley Water and Sewer Director <br /> Certified Mail# 7015 3010 0001 5577 5104 <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 /> 1. City of Greeley, 1100 10th Street, Suite 300, Greeley CO 80631 (970)350-9811 <br /> 2. Weld County, 91510th Street, Greeley C080631 (970)356-4000 <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 the Rules and all applicable requirements under the Act." <br /> Signature of Pe m' e, Aerator 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 />