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OF Cps <br /> tee" 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/SURETY REDUCTION <br /> Please indicate if you are requesting: <br /> RECEIVED <br /> FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA(per Rule 4.17) ❑ v JUN 01 2016 <br /> ACREAGE REDUCTION(PARTIAL RELEASE per Rule 4.17) JiVISION OF RECLAMATION <br /> I wish to release 3 a, S acres at this time. A- - /I MINING AND SAFETY <br /> You will need to submit with this request: a map showing the acreage to be released from the current <br /> permit and updated mining and reclamation plan maps that will accurately depict the new permit <br /> boundary if the release is approved. <br /> SURETY(Bond)REDUCTION(per Rule 4.14) ❑ <br /> If you are requesting a surety(bond)reduction you will need to include with this request a new estimate <br /> of the actual cost to reclaim the site based on what it would cost an independent contractor to complete <br /> reclamation, including unit costs for reclamation activities as appropriate to the operation to comply <br /> with the provisions of Rule 3.1 and the Permit's approved Reclamation Plan. <br /> V File No.: M- 01 b Site Name: CA'L OW L-L t5207/ S 3 <br /> County: 07E-90 <br /> Permittee: C4L0wCLL SRO-ME-R-S Annual Fee/Report CW <br /> a,�a� RO � � No Violations <br /> Permittee Address: <br /> Operator(If Other than Permittee): <br /> Permittee Representative: <br /> Certified Mail# <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 /> Dr✓wl s 4). C+1-j9 w l✓L L <br /> 05-0a & RD 19 <br /> P- 4, 6ax 7� <br /> C14-C--lO%NE WELLS , CO F69/0 <br /> P U"c �pq — q(0,7 3 3 0g Continue on following page.. <br />