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Operator(If Other than Permittee): <br /> Permittee Representative: Craig Rasmuson <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 /> Trenton Korby PO Box 337282 9703022994 <br /> James Chick PO Box 337282 970.396.6541 <br /> RZ Properties Investments, LLC PO Box 337282 970.518.6205 <br /> Mike and Julie Lordemann PO Box 337282 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 /> Craig Rasmuson Digi ally signed by Craig Rasmuson <br /> e:2025.04.22 09:03:52-06'00' 2 3 Z02- <br /> Signature of Permittee, Operator or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2L) 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 /> MineralsRcic—Requesfform 20Scp2017 <br /> Page 2 of 2 <br />