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*. COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br /> *, ,6 <br /> 187 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 `� <br /> ACREAGE REDUCTION (PARTIAL RELEASE) <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 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- 1983-213 site Name: Lehr Sand and Gravel Pit <br /> County:Weld <br /> Permittee:Weld County <br /> Operator (If Other than Permittee):Weld County Public Works <br /> Permittee Representative: Clay KIfT mi <br /> Certified Mail# 7011 2970 0002 2028 4555 <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 /> LG Everest Inc., PO BOX 5829 SIOUX FALLS, SD 57117-5829 <br /> Annual Fee/Report CW <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 accordance with these Rules and all applicable requirements under the Act." <br /> .1 5/26/16 <br /> Signat a 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 />