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Operator(If Other than Permittee): <br /> Permittee Representative: John Warred <br /> Certified Mail# 7018 2290 0001 9491 3608 <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 /> Town of T mnath 4750 Signal Tree Drive, Timnath, CO 80547 (970) 224-3211 <br /> In accordance with Rule 4.1 T 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 satisfie ordance with these Rules and all applicable requirements under the Act." <br /> Signs Permittee, Operator or their authorized agent D6te <br /> Important: 117 accordance with Mules 4.14.2(a) and 4.1?.1(3) This release request must be submitted to the <br /> Division via certified mail and separated om any other correspondence to the Division. <br /> AS'vmelsRelcaseRccp�atPorm MepM 7 <br /> Page 2 of <br />