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Operator(If Other than Permittee): Bower Brothers Construction INC. <br /> Permittee Representative: Richard E BOwerll <br /> Certified Mail # 595 Taylor craig colo 81625 <br /> 1n 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 /> Georg Duzik 94824 by 40 craig 81625 <br /> Ashbaugh Family po box 398 craig 81626 <br /> ,�;e, lz)Uc 9,d rnct Cgin 70- C/ <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 /> 9-- al� <br /> Si ature of Permittee, Operator or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2(a) and 4171 Q) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division <br /> M,n-1, ele—R,q-,tF.,.20Sep2017 <br /> Page 2 of 2 <br />