Laserfiche WebLink
Operator(If Other than Permittee): <br /> Permittee Representative: Ryan Stitt <br /> Certified Mail # <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 /> Denver Water 1600 W. 12th Ave, Denver, Co 80204 303-628-6539 <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 /> 8/6/24 <br /> Si at re o e ittee, perator or their authorized agent Date <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 anv other correspondence to the Division. <br /> MineralsReleaseRequestForm Mep2017 <br /> Page 2 of 2 <br />