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ti <br /> pF coz0 <br /> 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 PE AULA <br /> Please indicate if you are requesting: Q)P <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 12.49 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 A) <br /> County: w.1d r <br /> PR04 <br /> Permittee: Feld County ' <br /> Operator (If Other than Permittee): Feld county Public Works ND\IX0 ions <br /> Permittee Representative: Clay ximmi <br /> Certified Mail# 701(oO?50ooco)Qna 21,2S <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 /> Atu kv�z— 11/30/16 <br /> Signalilre 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 />