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Operator (If Other than Permittee): <br /> Permittee Representative: Wyatt Webster, Environmental & Land Manager <br /> Certified Mail 4 <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 /> City of Longmont 385 Kimbark Street, Longmont, CO 80501 303-651 -8330 <br /> Bigelow Investments LP 2401 Ginny Way, Lafayette, CO 80026 <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 /> \ 08/03/2023 <br /> Signature of Permittee, Operator or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2(a) and 4.17.10 This release request must be submitted to the <br /> Division via certified mail and separate°from ant, other correspondence to the Division. <br /> MineralsReleaseRequesfform 20Sep2017 <br /> Page 2 of 2 <br />