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�F CoZ <br /> COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br /> *� *C�s7s 303 1313 Sherman Street, Room 215, Denver,Colorado 80203 P � )h 866-3567 <br /> " � <br /> REQUEST FOR FULL OR PARTIAL RELEASE OF PERMIT AREA <br /> Please indicate if you are requesting:uestin : 0ec 0 6101 <br /> F!,�� <br /> FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA ❑ �tolv0 <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 6.14 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, rmit boundary. <br /> File No.: M- 1978-210 Site Name: Geisert Pit(Cell D) <br /> R04 <br /> County: Feld I <br /> Permittee: Feld County ✓ No Violations <br /> Operator (If Other than Permittee): weld county Public Works <br /> Permittee Representative: clay Kimmi <br /> Certified Mail# c.I�o o Tso C>c>c7o 7(1 36� <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 /> 141:;; 11/30/16 <br /> Signa re 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 />