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Operator(If Other than Permittee): <br /> Permittee Representative: Jodi Schreiber <br /> Certified Mail# -7 o 4 -i ao om (g 7 00 <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 /> Stonewall Springs Quarry PO Box 75568,Colorado Springs, CO 80970-5568 719-499-4390 <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 /> 7/26/2019 <br /> Sibp6e 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 /> MtneralsReleaseRequmffe m Mep2017 <br /> Page 2 of 2 <br />