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\fA #% 00 COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br /> 1876• 1313 Sherman Street, Room 215, Denver, Colorado 80203 ph(303) 866-3567 <br /> REQUEST FOR FULL OR PARTIAL RELEASE OF PERMIT AREA/SURETY REDUCTION <br /> Please indicate if you are requesting: <br /> FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA (per Rule 4.17) I .CE•'Ver) <br /> ACREAGE REDUCTION (PARTIAL RELEASE per Rule 4.17) ❑ JUN 12 2017 <br /> 1 wish to release 1 .00acres at this time. nu .QIVISIONOFRECLq <br /> . <br /> You will need to submit with this request: a map showing the acreal-- "� roiA��P� frnm't WG&SAFETY <br /> permit and updated mining and reclamation plan maps that will acci SL01 xmit <br /> boundary if the release is approved. <br /> ✓ Complied <br /> SURETY (Bond) REDUCTION (per Rule 4.14) ❑ ✓9 Violations: <br /> If you are requesting a surety (bond)reduction you will need to inc ACY -ow estimate <br /> of the actual cost to reclaim the site based on what it would cost an mucNV',►u�„t .,) 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 they-ermit's approved Reclamation Plan. <br /> File No.: M- I"�1 20 d - 0 site Name:West Side Placer Bulk Sample <br /> County: Moffat <br /> Permittee:AuPt Industries LLC /Peter Freedman <br /> Permittee Address: PO BOX 1424 <br /> Edwards, Colorado - 81632 <br /> Operator(If Other than Permittee):AuPt Industries LLC <br /> Permittee Representative: Peter Freedman <br /> Certified Mail# 7016 3010 0000 7659 2520 <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 /> Continue on following page.. <br />