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Operator(If Other than Permittee): <br /> Permittee Representative: Angela Bellantoni of Environmental Alternatives Inc. <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 /> US BLM Royal Gorge Field Office 3028 East Main Street, Canon City, CO 81212 (719) 269-8551 <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 /> Angela M. Bellantoni Digitally signed Angela M.- Bellantoni July 6, 2022 <br /> Date:2022.07.06 10:55:10 06'00' <br /> Signature of Permittee, Operator or their authorized agent Date <br /> Important: In accordance with Rules 414 2(a) and 4.17.1(3) This release request must be submitted to the <br /> Division via certified mail and separate om any other correspondence to the Division. <br /> MmmisRelea Requesffoim Mep2017 <br /> Page 2 of 2 <br />