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A <br />4 (FORM 2 - Public filing) <br />11. Describe proposed surface excavation or other land disturbance, including roads, pits, trenches, waste piles, drill pads and <br />12. Proposed Disturbance (approximate) Describe the proposed drilling to be conducted, including anticipated number of holes, <br />diameter, depth, location, etc... Submit additional pages if necessary: <br />A. Drill Pads: Quantity Average Width (ft) Average Length (ft) <br />B. Drill Holes: Quantity Depth (ft) Diameter (in) <br />C. Mud Pits: Quantity Average Width (ft) Average Length (ft) <br />Average Depth (ft) <br />Described proposed underground work, including reopening of old workings, advancement of adits or shafts, <br />trenches, pits, cuts, pock dumps, or other types of disturbance, describe type, quantity and general dimensions: <br />F. Other Disturbances (please describe): <br />� not b 41 LM ve <br />G. Indicate Chemicals and Fuels used or stored on site. List type, quanti and method to store. <br />Q li e7/! e° 11 <br />F. New Road(s): Length (ft) Width (ft) <br />Significantly Upgraded Road(s) Length (ft) Width (ft) <br />Are culverts or other crossings proposed? If so, please describe: _AM <br />