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Of'CO�O <br /> COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br /> 1313 Sherman Street, Room 215, Denver, Colorado 80203 ph(303)866-3567 <br /> 876 <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) El <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 8.45 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- 1978-210 Site Name: Geisert Pit(Cell c) - ^� <br /> AR04 <br /> County: Weld (--i(GOMPLIED! <br /> ✓ No Violations <br /> Permittee: Weld County <br /> Operator (If Other than Permittee): Weld county Public works <br /> Permittee Representative: Clay Kimmi <br /> Certified Mail# 7016 o 75o v oc)o -2"1 3`s 20�ia <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 /> WELD COUNTY, 1150 O ST.,GREELEY,CO 80631-9596 <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 /> OL1 11/30/16 <br /> Signati& of Permittee, Operator or their authorized agent Date <br /> Important. In accordance with Rule 4.17.10This release request must be submitted to the Division <br /> via certified mail and separate from any other correspondence to the Division. <br />