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r <br /> Operator(It' )the rthan PcrtniItec): <br /> Permittee Rerresentatke: Kelly Hodge <br /> Certilied Mail #In accordance ccith Rule 4.1; 1(2)the Operator shall include the names,addresses and phone numbers of all <br /> o\�ners ref record to the affected land. Please attach additional sheets for this information if required <br /> Name Address Phone Number <br /> -------- <br /> In accordance ith Rule 4.1 1(4). if requesting a partial acreage release the Operator or their agent N1('ST sign that <br /> theN hace complied with the folloc\inL statement• "AII applicable portions ofthc Reclamation Plan rcquiremcnts <br /> hate been satistied in accordance ccith these Rules and all applicable requirements under the Act.' <br /> � _ 4-34-2019 <br /> nanuc �crt t °e. Operator <br /> t Date <br /> /ru ,ornnu. In urc<,rciccnrr �+t i7Zrcicr c I 1 a 'iui grin 4.1" 1 c3) Uric rc Iecl.ce re( he.ctihmrtted it, tlw <br /> t.�n;%mn rice cc r li is cl��tcril caul,cc tit(! 'urn um_other tw!:wc yni let we In file Divi.ciml. <br /> Pa�L 2 r(2 <br />