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Operator(If Other than Permittee): Kirkland Construction, LLLP <br /> Permittee Representative: Tim Gerken - Telesto Solutions Inc. <br /> Certified Mail # -70 1-, <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 /> Galloway Inc. (Blue Valley Ranch) PO BOX 1120 KREMMLING CO 80459 (970) 724-3680 <br /> Mountain Parks Electric, Inc. 321 W Agate Ave, Granby, CO 80446 (970) 887-3378 <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 /> ajl� 6r� 07/09/2020 <br /> Signature of Permittee, Operator or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2(a) and 4.171(3) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division. <br /> Mi—IsReleweRequwFocm 20Sep2017 <br /> Page 2 of 2 <br />