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Operator(If Other than Permittee): <br /> Perm ittee Representative: Mike T. Weldon <br /> Certified Mail# 0 4' 30 y0 ono 1 /b f 4(v,3 0 <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 /> Tyler Pratt 871 E. Main St. vernal, Utah 84078 4356324298 <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 /> on <br /> Mike T. Weldon Date: <br /> signed 515by :3642-06' 0' 5-5-2022 <br /> Date:2022.05.05 15:36:42-06'00' L L <br /> Signature of Permittee, Operator or their 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 /> MmeralsReleaseRequesfform 20Sep2017 <br /> Page 2 of 2 <br />