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Operator(If Other than Permittee): (same) <br /> Permittee Representative: Lynn Mayer ShultS <br /> Certified Mail # <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 Address Phone Number <br /> L.G. EVERIST, INC. 7321 E 88TH AVENUE 303-286-2247 <br /> SUITE 200 <br /> HENDERSON, CO 80640 <br /> ANADARKO/ KERR-MCGEE ATTN: TRAVIS HOLLAND-APC (720) 929-6000 <br /> OIL & GAS ONSHORE LP PROPERTY TAX <br /> PO BOX 173779 <br /> (Oil & Gas rights and/or DENVER, CO 80217-3779 <br /> equipment) <br /> CRESTONE PEAK 1801 California Street, Suite 2500 720-410-8500 <br /> RESOURCES, LP Denver, CO 80202 <br /> (Oil & Gas rights and/or <br /> equipment) <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 /> I <br /> f� a <br /> ignature of Permittee, Operator or their authorized agent Date <br /> Important In accordance with Rules 4.14.2(a) and 4.17.1(3) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division. <br /> MmeralsReleaseRequesfform 20Sep2017 <br /> Page 2 of 2 <br />