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H <br /> Operator(If Other than Permittee): HOIcim - MAM R, Inc. <br /> Perrnittee Representative: Wyatt Webster; wyatt.webster@holcim.com <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 /> U.S. Fish & Wildlife Service 6550 Gateway Road,Commerce City,CO 80022-4358 303-729-2262 <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 /> AD/2 <br /> Signaturfof Permittee,Operator or their authorized agent Date <br /> Important.- In accordance with Rules 4 14 2(a)and 4171(3) This release request must be submitted to the <br /> Division via certired mail and separate from any other correspondence to the Division. <br /> MinerahM aseRequestFom 20Sep2017 <br /> Page 2 of 2 <br />