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Operator(If Other than Permittee): N/a <br /> Permittee Representative: Jerod Timothy <br /> Certified Mail# <br /> In accordance with Rule .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 /> City of Grand Junction 333 west Ave,Building C,Grand Junction,CO 81501 970-244-1 565 <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 actor once with these Rules and all applicable requirements under the Act." <br /> Si aturre f Permittee, Operator or their auth rized agent Date <br /> Im or ant: In accordant with Rules 4.14. and 4.17.1 3 This release request must be submitted to the <br /> Division via certi ied Mai and se arate om any other correspondence to the Division. <br /> MWMI$Rek=RequWFo 2OW017 <br /> Page 2 of 2 <br />