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Operator(If Other than Permittee): Castle Aggregate <br /> Permittee Representative: Jerald Schnabel <br /> Certified Mail # 9589 0710 5270 0892 9769 23 <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 /> US Forest Service <br /> Amy Tittenngton Forest Geologist/Minerals Program Manager 320 US Highway 285 PO Box 219 Fairplay, CO 80440 p•719-836-2031 c.719-838-0699 <br /> Colorado Spnngs Parks,Recreation&Cultural Services <br /> David Deitemeyer Senior Landscape Architect,PLA,ASLA,NRPA 1401 Recreation Way Colorado Springs, CO 80905 (719) 385-6515 <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 /> f <br /> Sigijature of Permittee, Operator or their authorized agent Date/ �J <br /> iI <br /> Imj rtant: 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 /> MineralsReleaseRequestForm 20Sep2017 <br /> Page 2 of 2 <br />