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Operator(If Other than Permittee): <br /> Permittee Representative: Craig Rasmuson <br /> Certified Mail # 9589 0710 5270 1197 9045 98 <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 /> Trenton Korby PO Box 337282 Greeley, CO 80633 970.302.2994 <br /> James Chick PO Box 337282 Greeley, CO 80633 970.396.6541 <br /> RZ Properties Investments, LLC PO Box 337282 Greeley, CO 80633 970.518.6205 <br /> Mike and Julie Lordemann PO Box 337282 Greeley, CO 80633 970.405.0960 <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 /> Craigpalm USUrI Digitally signed by Craig Rasmuson <br /> r� Date:2024.08 20 11:58:23-06'00' <br /> Signature of Pennittee, Operator or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2(a) and 4.17.1 Q) This release request naust be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division. <br /> Almer,ikReleawRNuectPnrm 206ep2u17 <br /> PaFe 2 of 2 <br />