Laserfiche WebLink
Operator (If Other than Permittee): H O I ci rn - WC R, Inc. <br /> Permittee Representative: Landon Wilhite <br /> Certified Mail # 7019 2970 0000 3231 3858 <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 /> Holcim - WCR 1687 Cole Blvd., Suite 300, Golden CO 80129 508 530 8783 <br /> Diamond G Concrete Company PO Box 54, Longmont CO 80502 303 702 0708 <br /> Golden Farm LLLP PO Box 54, Longmont CO 80502 303 702 0708 <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 /> May 11 , 2023 <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 20Sep2017 <br /> Page 2 of 2 <br />