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DocuSign Envelope ID:FD021554-0556-4D8C-956F-8FO918E38180 <br /> Operator(If Other than Permittee): <br /> Permittee Representative: Shannon Robbins <br /> Certified Mail # �0! 9 a alp� 0000 ,�3 96 a&ol <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 /> Barefoot LLC 6465 S.Greenwood Plaza Blvd.,Suite 700,Centennial,CO 80111 303-706-9451 <br /> Barefoot Residential LLC 6465 S.Greenwood Plaza Blvd.,Suite 700,Centennial,CO 80111 303-706-9451 <br /> St.Wain Lakes Metropolitan District No. 1 550 W.Eisenhower Blvd.,Loveland,CO 80537 970-617-2466 <br /> Town of Firestone 151 Grant Avenue,P.O.Box 100,Firestone,CO 80520 303-833-2291 <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 /> FS <br /> DocuSlyned by: <br /> "Vu rbwws 10/22/2020 1 2:32 PM MDT <br /> Sig'n-fffiWWTWffiittee, Operator or their authorized 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 /> MmcialsRcleaieRequestFoun 20Sep2017 <br /> Page 2 of 2 <br />