Laserfiche WebLink
Operator(If Other than Permittee): <br /> Permittee Representative: Chris Zadel <br /> Certified Mail # <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 /> Pioneer Land Company, LLC 4409 Coriolis Way, Frederick, CO 80504 (303) 550-5957 <br /> Bennett Reservoir, LLC 80 South 27th Avenue, Brighton, Co 80203 (303) 659-7373 <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 /> Chris Zad e I Digitally signed by Chris 2/1 8/22 <br /> Date:2022.02.18 07:09:42-0-07'00' <br /> Signature of Permittee, 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 /> MineralsReleaseRequesfform 20Sep2017 <br /> Page 2 of 2 <br />