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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203 ph(303) 866-3567 <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 Ei <br />ACREAGE REDUCTION (PARTIAL RELEASE) 11 <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 161-01 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- 1999-120 Site Name: Fort Lupton Sand and Gravel <br />County: Weld <br />Permittee: L.G. Everist, Incorporated <br />Operator (If Other than Permittee): same <br />Permittee Representative: Lynn Mayer Shults (office -303-286-2247) <br />Certified Mail# 7002 0860 0006 1860 4479 <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 />L.G. Everist, Incorporated - Corporate HQ and Colorado addresses: <br />Corporate Office - 300 S Phillips Ave, #200, Sioux Falls SD 57104 (605-334-5000) <br />Mountain Division - 7321 E 88th Avenue, #200, Henderson CO 80640 (303-286-2247) <br />City of Aurora - 15151 E Alameda Pkwy, Suite 3600, Aurora, CO 80012 <br />Ted Hartfelder, Water Projects Manager - 303-319-2342 <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 />satin, ed in accordance with the e Rules and all applicable requirements under the Act." <br />1 � <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 />