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Qperator(If Other than Permittee): same <br /> Permittee Representative: Julie Mikulas 970-407-3631 <br /> Certified Mail # 7019 1640 0000 2371 6663 <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 /> City of Greeley, Attn Terry Farril 1001 11th Ave, Greeley, CO 80631 970-350-9813/970-573-2829 <br /> Great Western Railway of Colorado, LLC 252 Clayton Street,4th Floor, Denver, CO 80206 Attm President of Real Estate <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 /> ignature of Permittee, Operator or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2(a) and 4.17.1 Q) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division <br /> MineralsReleaseRequesfform Mep2017 <br /> Page 2 of 2 <br />