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Operator(If Other than Permittee): same as permittee <br /> Permittee Representative: Mark Heifner <br /> Certified Mail# 7D g -2.'70 Dnp 64746 g g?'p <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 /> Colorado Farms, LLC 6460 S. Quebec St. Centennial, CO 80111 303-221-1453 <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 /> 2 2 I-,2O 1 <br /> Signature of Permittee, Operator or their authorized agent bate <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 /> MinrnlsReteuc equestform-OScp'_017 <br /> Page 2 of 2 <br />