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Operator(If Other than Permittee): <br /> Perm ittee Representative: Jodi Schreiber <br /> Certified Mail# <br /> q Xc1 Olio Salo l,A-14-1 <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 /> Rio Grande Canal Water Users Association PO Box 288, Monte Vista, CO 81144 719-850-1111 <br /> Burton Farms LLP 18918 County Road 15, Del Norte, CO 81132 719-657-2892 <br /> In accordance with Rule 4.17.1(4), if requesting a partial acreage release the Operator or their agent MUST sign that <br /> the\ 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 /> 2/17/2025 <br /> Sign ur of Pen ee. 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 any other correspondence to the Division. <br /> ALnerahReleaseRequeerFnrm 20Sep20I7 <br /> Page 2 of 2 <br />