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Operator (If Other than Permittee): Lessee: Crossfire Aggregate Services, LLC <br /> Permittee Representative: Todd Fisher assisted by Nathan A. Barton <br /> Certified Mail 44 7019 0700 0002 1644 7620 <br /> In accordance with Rule 4.17.4(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 /> LBC R, LLC 1440 Blue Sage Court, Boulder, CO 80305 303-887-3395 <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 /> j/7/1-^ nir, ZiY1P--) <br /> S atur- o, Permittee, Otor or their authorized agent Date <br /> ) i 1--6lwr-- <br /> Important: 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 /> MineralsReleaseRequestFonn 20Sep2017 <br /> Page 2 of 2 <br />