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Operator (If Other than Permittee): <br /> Permittee Representative: Darren Janssen (303) 526-8842 djanssen@crccllc.com <br /> Certified Mail # 7019 07,00 o000 o zi S 87(a1 <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 /> Doug Hasser 5099 CR E, Lamar, CO 81052 (303) 336-5173 <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 /> /,Z 9 <br /> 34 <br /> Signatu ernkir , Operator or their authorized agent Date <br /> Important: In accordance with Rules 414.2(a) and 4171(3) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division. <br /> MincralsRcicascRcquesfform Mep2017 <br /> Page 2 of 2 <br />