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Operator(If Other than Permittee): <br /> Permittee Representative: Eric R. Stearns <br /> Certified Mail # 7011-3500-0000-0549-6847 <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 /> 5460 S Quebec St Ste250 Greenwood <br /> Puckett Land Company village Co 80111 303 763 1000 <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 /> 07/28/2021 <br /> Signature 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 /> 161mQa13Alc1c=cPequatFa m Mq�1017 <br /> Pap 2 of <br />