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Operator(If Other than Permittee): <br /> Pertnittee Representative: Tom Brubaker <br /> Certified Mail # e)61 g z�So 0001 <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 /> Valco, Inc. 9121 Sunshine Meadow PI, Parker, CO 80134 303-862-7569 <br /> Daniel L. Lytle 19241 CR GG. 5, Rocky Ford, CO 81067 <br /> City of Aurora ATT: Jeff Hanna 1515 E.Alameda PKM,Suite 3200,Aurora,CO 80012 <br /> Donald Memeda 21501 HW 50, Rocky Ford, CO 81067 <br /> Don Hansen 21621 HWY 50, Rocky Ford, CO 81067 <br /> Otero County Public Works P.O. Box 511 La Junta, CO 81050 <br /> Southeast Colorado Power Association P.O. Box 511, La Junta, CO 81050 <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 /> - Z0 <br /> Signature of Pertnittee, 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 anv other correspondence to the Division. <br /> MmetalsReleaseReques[Form 20Sep2017 <br /> Page 2 of 2 <br />