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C) <br /> RPM,Inc.,25049 E.Alder Dr.,Aurora,CO 80016 Phone:(303)854-7499 Email:hlhumphries2@comcast.net <br /> Operator(If Other than Permiticc): <br /> Pennittee Representative: Tyson deist <br /> Certified!Nail 0 J <br /> .o241 CD aey4, <br /> In accordance with Rude 4,17.1(2)the Operator shall include the names,addresses and phone number of all <br /> Owners Ol'rccord to the atTected land Please attach additional sheets for this information if required. <br /> Name Address Poe Number <br /> Mile 250 LLC 1853 Chesapeake Circle, Apt B 303-293-9021 <br /> Johnstown, CO 80534 <br /> In acwidance with Rule 4.17.tt4I,if requesting a partial acreagr relcase the Operator or their agent MUST-sign that <br /> they have%.ornplrrd with the following stutctnenr: "All applicable Ihhruons of the Iteclamation Plan requtrenunts <br /> have been satisfied in accordance with these Rules and all applicable requirements under the Act." <br /> Sign Permitter,Operator or their aut1tori7ed agent Bate <br /> lnworlanl. In uc'c't» ce with Rules 4.l4._lai and 4.17.1(3) 7hi�release rc•uuest one r(he,aultrxttr .l fu the <br /> Division via ccrfilied mail and Fgvrafe jro m ant-other correspondcmr a to the Diri.ciurr <br /> i'a�E ut 2 <br /> 3 <br />