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AME WHE )F RECLAMATION, MINING AND SAFETY <br /> M-1983-176 SLO1 15, Denver,cblorado 80203 ph(303)S66-3567 <br /> ✓ Annual Fee/Report: CW <br /> J No Violations <br /> ltwur,n i run r uuu un rARTIAL RELEASE OF PERMIT AREA <br /> Please indicate if you are requesting: RECEIVED <br /> ZD <br /> FULL/FINAL RELEASE OF ENTIRE PERMITTED AREA Fl JUL 0 7 2017 <br /> ACREAGE REDUCTION (PARTIAL RELEASE) F DNISIQNOFRECLAMATION <br /> If you are requesting an acreage reduction, you will need to specify how many acres you � NI ' DE?Y <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- Z f f l '0151? Site Name: _ _2EE.6 2177 <br /> County: <br /> Permittee: 07l <br /> Operator(If Other than Permittee): _ <br /> Permittee Representative: <br /> Certified Mail# <br /> In accordance with Rule 4.17.1(2)the Operator shall include the names, addresses and phone numbers <br /> of all owners of record to the affected land. Please attach additional sheets for this information if <br /> required. <br /> Al/ <br /> ` f'n <br /> ,9 &04Z� <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 acc rdance with these Rul s and all applicable requirements under the Act.- <br /> r / <br /> Signature of P rmittee, Operator or their authorized agent Date <br /> Important: In accordance with Rule 4.17.10)This release request must be submitted to the Division <br /> via certified mail and separate from any other correspondence to the Division. <br />