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Operator (If Other than Permittee): <br /> Permittee Representative: Katie Conrado <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 /> The Joe P Conrado Trust PO Box 1550, Meeker, CO 81641 970-878-5751 <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 /> 5f 2.& I2Z <br /> ignature of Permittee, Aerator 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 /> it l me,a I,Ike easeRequestf oim 20Sep2O17 <br /> Page 2 of 2 <br />