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Operator (If Other than Permittee): (Same) <br /> Permittee Representative: Lynn Mayer Shults <br /> Certified Mail # 7016 1370 0001 0670 4188 <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, SUITE 200 303-286-2247 <br /> HENDERSON, CO 80640 <br /> (Property Owner& Permittee, <br /> Parcel#020135100009) Contact: Lynn Mayer Shults <br /> Imshults@lgeverist.com <br /> Anadarko Land Corp. c/o Senior Landman -Weld County 720-929-6000 <br /> 1099 18th Street, Suite 1800 <br /> (Oil &Gas rights on the parcel, Denver, CO 80202 <br /> Weld Assessor Acct. N0085786) <br /> Plains Marketing LP c/o Property Tax Dept 713-646-4100 <br /> PO Box 4648 <br /> (Lease, Oil Transload operation Houston, TX 77210-4648 <br /> and pipeline on parcel, Weld <br /> Assessor Acct. P9102557) <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 /> o& 2-a c <br /> Signature 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 /> MineralsReleaseRequesfform 20Sep2017 <br /> Page 2 of 2 <br />