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Operator(If Other than Permittee): same as permittee - L.G. Everist, Incorporated <br /> Permittee Representative: Lynn M. Shults, Regulatory Mgr(303-514-2778, Imshults@lgeverist.com) <br /> Certified Mail# 7020 0090 0001 0134 6362 <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 /> L.G. Everist, Inc. Matt Noteboom 303-286-2247 <br /> Vice President <br /> 7321 E 88th Avenue, Suite 200 <br /> Henderson, CO 80640 <br /> City of Aurora Richard VidmarWater Resources Manager 303-739-7326 <br /> 15151 E Alameda Parkway, Suite 3600 <br /> Aurora, CO 80012 <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 /> A0,- Gam), <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 /> MmeralsReleaseRequesfform Mep2017 <br /> Page 2 of 2 <br />