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Operator (If Other than Permittee): Transit Mix Concrete Co. <br />Permittee Representative: Brandon Heser <br />Certified Mail # 7017 1070 0000 7469 0102 <br />In accordance with Rule 4.17.1(2) the Operator shall include the names, addresses and phone numbers of all <br />owners of record to the affected land. Please attach additional sheets for this information if required. <br />Name <br />Address <br />Phone Number <br />Security Water District (Enterprise) 231 Security Blvd., Colo. Springs, CO 80911 (719) 392-3475 <br />Fountain Mutual Irrigation Company P.O. Box 75292 <br />Colo Springs, CO 80970 (719) 598-9048 <br />KDW Trust #1 Block 260 Ltd 3 Widefield Blvd. <br />Colo. Springs, CO 80911 <br />In accordance with Rule 4.17.1(4), if requesting a partial acreage release the Operator or their agent MUST sign that <br />they have complied with the following statement: "All applicable portions of the Reclamation Plan requirements <br />have been satisfied in accordance with these Rules and all applicable requirements under the Act." <br />Please Note: The area for which release is being sought has not been affected by CMCITMCC's mining or reclamation operations, i e. no mining occurred <br />ae,� <;�� — - - G/ qt Zoa <br />Signature of Permittee, Operator or their authorized agent Date <br />Important.- In accordance with Rules 4.14.2(a) and 4.17.1 0) This release request must be submitted to the <br />Division via certified ied mail and separate from any other comes ondence to the Division. <br />Minash LIcueRequmtFamMcp2017 <br />Page 2 of 2 <br />