Laserfiche WebLink
Operator (If Other than Permittee): NA <br />Permittee Representative: Brad FanCher <br />Certified Mail # 102-0 2J-150 o6o Z 1263 X21 2 - <br />In <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 <br />Loveland Ready -Mix Concrete, Inc. <br />Address Phone Number <br />PO Box 299, Loveland CO 80539 970.667.2680 <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 />PI'Lls J,-� <br />-SVFn`ature of Permittee, Operator or their authorized agent <br />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 />MmeralsReleaseRequesfform 20Sep2017 <br />Page 2 of 2 <br />