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Operator(If Other than Permittee): <br /> Permittee Representative: John Henderson, Attorney at Law <br /> Certified Mail 4 <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 /> Fontanari Family 3316 E 3/4 Road 970 434 7948 <br /> Revocable Trust, Clifton, CO 81520 <br /> Rudolph Fontanari, <br /> Trustee <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 /> Signature lSf Permittee,Operator or their uthorized agent Date/f,/p —4AV <br /> Important: In accordance with Rules 4.14.2()and 4.17.1 L) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division. <br /> Mincm1sRc1mxRcq=mFarm Mcp2017 <br />