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of epto <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />*8 1313 Sherman Street, Room 215, Denver, Colorado 80203 ph(303) 866 -3567 <br />REQUEST FOR FULL OR PARTIAL RELEASE OF PERMIT AREA <br />Please indicate if you are requesting: $ D -J 1> QL" v e--t-1� tJ <br />FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA ❑`� IZE'Zv F-ST" � P4--- I <br />ACREAGE REDUCTION (PARTIAL RELEASE) <br />If you are requesting an acreage reduction, you will need to specify how many acres you wish to remove <br />from the existing permit under this revision. I wish to release acres at this time. <br />You will also need to submit updated mining and reclamation plan maps that accurately depict both the <br />proposed acreage to be released from the current permit area, and the resulting new permit boundary. <br />File No.: M -1 2 a � Site Name:, <br />County:s/4/; C;Ae t <br />Perm <br />Operator (If Other than Permittee): <br />Permittee <br />Certified Mail# 767 of �, 5%� Q24,9 / 0'-/ Y L/ 20 ,W <br />In accordance with Rule 4.17.1(2) the Operator shall include the names, addresses and pho <br />of all owners of record to the affected land. Please attach additional sheets for this information if <br />required. <br />111111 .F 6r� L • <br />' go r l <br />In accordance with Rule 4.17.1(4) the Operator or their agent MUST sign that they have complied with <br />the following statement: "All applicable portions of the Reclamation Plan requirements have been <br />satisfied in accordance with these Rules and all applicable requirements under the Act." <br />Signature of Permittee, Operator or <br />�? 2-/3 <br />Date <br />Important: In accordance with Rule 4.17.1(3) This release request must be submitted to the Division <br />via certired mail and separate from any other correspondence to the Division. <br />