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Operator(if Other than Permittee): <br /> Permittee Representative: Ed Lafferty <br /> Certified Mail# 7015 0640 0007 2121 0378 <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 /> City of Aurora 15151 E Alameda Pkwy Ste 3600,Aurora Co 800121 303.739.7000 <br /> Hall-Irwin Aggregates, LLC 5586 W 19 St. Ste. 2000, Greeley, CO 80634 970.646.1236 <br /> K P Kauffman Company Inc 3615 S Huron St Ste 200, Englewood, CO 80110 303.825.4822 <br /> Carl F Eiberger 303 S Broadway Unit B-200, Denver, CO 80209 303.880.4001 <br /> H I B E LLC 5586 W 19 St. Ste. 2000, Greeley, CO 80634 970.646.1236 <br /> Aggregate Industries -WCR Inc 1687 Cole Blvd Ste 300, Lakewood, CO 80401 303.985.1070 <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 /> s 11 �i7/z/ <br /> Signature of Permittee, Ope or r 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 /> MmemisRcleaicReyueatForm 20Sep2017 <br /> Page 2 of 2 <br />