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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Release, Acreage Reduction, and Surety Reduction Notices Checklist <br />[}7 • County Commissioners _ <br />Specify Count x4154 <br />Address: <br />�fii'►� P RAcr. S v?,-r-, ) <br />. (7o)c ILD <br />G P,Rn,D �: ro <br />c xitAk <br />♦ Soil Conservation District VC-cc Specify SCD: M E5 � % \- <br />a ♦ Land Owner(s) - <br />Name: Ot As1-k S ,,, ieS}• roJ p, 1-NC.. V'^,Icd Le' c S <br />❑ ♦ Water Resources (If there is exposed groundwater) EPS Circle One: Y <br />• - Receive one paper copy of Application form, Legal Description and Location Map <br />