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Operator(If Other than Permittee): Otero County <br /> Permittee Representative: Lex Nichols <br /> Certified Mail# 14110 ©COC) O 6 8? -s-o 8 <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 /> Otero County 13 West 3rd St. LJ CO 719-383-3035 <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 /> /Z u l <br /> Signature of P rmittee,Operator or their aLffhorized 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 /> Page 2 of 2 <br />