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>t <br />5TATE OF COLOMDO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Deparrment of Narural Resources <br />t 3 t 3 She rrn, �m St., Rr�t)m _> 15 <br />Denver, Colorado 80203 COLORADO <br />Phone: (303) 866 -3567 R <br />1? I t r 4 1 t7 N O P <br />`101 RECLAMATION <br />FAX: 1.30_ }) 8. 2 -8106 Mpt MINING rG <br />OF RECLAMATION <br />SION SAE E <br />DM TY <br />h11NING AND SAFETY <br />MINERAL PROSPECTING DRILL HOLE <br />PERMANENT ABANDONMENT FINAL REPORT <br />Pursuant to the terms of 34- 32- 113(5.5)(d) and (e) of the Act, all information provided in this report shall be protected <br />as confidential information by the Mined Land Reclamation Board and shall never be a matter of public record. <br />Prospect Site Name: X FoSRMt9- <br />`{ _ Prospect NOI No.: P- X-Zo I I - Z.34o -'03 <br />Drill Hole I.D. No. 3 �o 11 $ 3 _ Pt-";T * (-- % g t - -,a B <br />Date Drilled: 91►3 13 _ _ Date Permanently Abandoned: 4 1 t 3 <br />OPERATOR: (PROSPECTOR) DRILLER: <br />Name: 3LVE MTN. ErvESL.(,� , INC.. Name: LAINE CiflbsTENSEN <br />Address: _ _3bo-1 Ll Rte. 65 �A ST 22 Na <br />Address: 118ao <br />City: 2A N 4f_Ly St,:- C o Zip: % N to 4 <br />Telephone No.: { R'10 ) to'I S: - 4 3 S 3 <br />LOCATION: <br />City: v R0 it A St.: CO Zip: <br />Telephone No.:( 1,0 a) 1 SS - 12.16 <br />The following information is required for all prospecting drill holes: <br />? �-: 1 f4 of the _ S **Al 114 of Section _ 116 , Township `3 N , Range 1'0- 1 W , <br />Prime Meridian, ,_, Q F F 14 T" _ _County. <br />If the area has not been surveyed, supply the Longitude . West and l..atitude _ North, <br />or attach a location map. preferably- a USGS Quad. <br />The following .additional information is required for artesian floating holes: <br />Distances must be orovidecl with an accurac of _3:200 feet (34 -32 -1 l3(5.5)(d)I <br />- ------------------ feet north Ysest outh from the south north section line <br />feet toast from thet west east section line <br />NOTE:: In the case of closely spaced drill holes having similar geologic and hydrologic characteristics, the Operator <br />may, with the approval of the Division. submit a single consolidated final report including the location of all <br />drill holes and a description of abandonment technique, In such a case. complete one abandonment final <br />report form and attach a list of drill hole locations. If more space is needed to provide an;% of' the <br />information fix this form, please attach separate sheets. <br />(Jllicc of <br />01nr , n1 <br />Vinod land Rae lemetwn De1 not • crand junctior, - Durango - rljvt, aiso lnl icbve minus <br />