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Operator (if Other than Permittec): <br /> - -------- ---- - --- -- ---------- -- ----------------------- ---- <br /> Permittee Representative: Katie COrlrad0 <br /> Ccrtted Mail # <br /> In accordance with Rule 4.17.1(2) the Operator shall Include the names, addlcsses and phone mimbcrs ofall <br /> owners of record to the affected land. Please attach additional sheets for this information if i-cqurred <br /> Name Address Phone Number <br /> In accordance with Rule 4.17.1(4), tf requesting a partial acreage release the Operator oI then 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 /> gn Attic of Pcrmittce, Operator or their authorized agent Date <br /> lay)o tant,- h7--accordcmc_e-tirith-Hines 4.14.2-(a) and-4.1 7.1(3) This release request must he submitted to the <br /> DiOsron viva certified mail-und sej�arate f-om airy other c:orresp_ondence to the Divisio{7. <br /> \I umi ahR L ai Rcyu.11 of m_Usrp?II17 <br /> rage 2 of 2 <br />