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Operator (If Other than Permittee): <br />Permittee Representative: Keith Nienhueser <br />Certified Mail # 7015 1520 0000 8509 3826 <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 />Jeff Schumacher <br />Address <br />Phone Number <br />18751 Rd 37.5 Sterling CO. 970-520-5683 <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 />r <br />05/01/2018 <br />ignature of Permittee, Operator or their authorized agent Date <br />Important:. In accordance with Rules 4.14.2(x) and 4.17.1 /3} This release request must be submitted to the <br />Division via certified mail and se arate from any other corres ondence to the Division. <br />MineraliMcueRequutPorm MepN17 <br />Page 2 of 2 <br />