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c <br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />FORM 2 (Public File) <br />NOTICE OF INTENT TO CONDUCT PROSPECTING OPERATIONS <br />FOR HARD ROCK/METAL MINES <br />CHECK ONE: There is NOI Number Already Assigned to this Operation <br />P -nf�` tam (Please reference the file number assigned to this operation) <br />New NOI <br />Modification to an Existing NOI <br />NOI# P- - (Provide for Modifications to an existing NOI) <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />I. GENERAL INFORMATION <br />2. <br />8. PROSPECTOR: II <br />Name: !tit G <br />Title: <br />Company Name: <br />Street: ; . <br />P.O. Box: <br />City: L_t)�O�il(0 �OOse5� (_ <br />State: t%) <br />Zip Code:() <br />Telephone Number: 1):32 1 <br />Fax Number. <br />(office use only) <br />Name: t <br />Title: <br />Company Name: <br />Street: X# - <br />City: ti'ido �Lr <br />State: 1A <br />Zip Code: <br />Telephone Number. (71q) � 7 �t I - /() ( 3 <br />Fax Number <br />9. APPLICATION FEE: $86. (NOIs and modifications require an $86 fee which must accompany this notice or it cannot be <br />processed by the Division). <br />10. LOCATION INFORMATION: <br />County <br />PRINCIPAL MERIDAN (check one) 6`h ( olorado 010s' (New Mexico) n (Ute) <br />SECTION (write number): S A , <br />TOWNSHIP (write number and check direction) T North South ' BVi y Lick Yet <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />