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Operator(If Other than Peruuttee): <br /> Pennrttee R.epresentatic•e Daniel Tacker <br /> Certified hfarl <br /> ��y .Zysty 06oe> %czq <br /> In ac cot dance xzth Rule 4_1 It'-)the Operator shall include the names_addresses and phow muubers of all <br /> oumer of record to the affected land. Please attach additional sheets for this inforutatron if reTured <br /> Name Address Phone\umber <br /> ,k*arsas uro-,nawater 5 Reserwo:r Assr 205 S. Main St., Fowler, CO 81309 719 826-2597 <br /> In accordance ic-rth Rule 4 17 1(4).if requesting a parhai acreage release the Operatot or then agent MUST sign that <br /> they have complied with the following statenrnt :ill apphcable pauoas of the Reclamation Plan requirements <br /> have been satisfied in accordance ith these Rules and all applicable regturenxrnts undet the Act" <br /> W_^ 0 1 -�- 4� <br /> Stgna ire of P _Operatof or their authorized agent Date <br /> Important In accor-dance frith Rules 4.14.2tn1 cind 4.1-1(,) This release request»test be submitted to the <br /> DrOsion A la cergfted mah'and separate from ant orher con-escondence to the Dwsron <br /> Nze:of 2 <br />