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Operator (If Other than Permittee): <br />Permittee Representative: Laura L. Schroetlin <br />Certified Mail # 70160910000126932894 <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 />Harvey Colglazier 41427 Co Rd 12, Holyoke, CO 80734 970-854-2796 <br />John R. Ptomey 08004 Co Rd 49, Holyoke, CO 80734 970-854-3036 <br />Eugene Kumm 49493 Co Rd 12, Holyoke, CO 80734 970-854-3483 <br />Poos Family Revocable Trust 47421 Co Rd 6, Holyoke, CO 80734 970-854-3340 <br />Schneller Enterprises Inc PO Box 147, Holyoke, CO 80734 970-854-3244 <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 of Permittee, Operator or their authorized agent Date <br />Important: In accordance with Rules 4.14.2(a) and 4.17.10) This release request must be submitted to the <br />Division via certified mail and separate from any other correspondence to the Division. <br />MinmisReleweReque from 20Sep2017 <br />Page 2 of 2 <br />