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STATE of COLOFADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Depanr czi <br /> C O L D R A D O <br /> Derve=s.C:otr,rado t3i;201 :, 1 �- r S I U �i O F <br /> Phone: 3t13' 866-336- RECLAMATIOIN <br /> FAX: 30 8;;-Fi06 MINING <br /> SAFETY <br /> MINERAL PROSPECTING DRILI.HOLE <br /> PERIMANENT 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 beprotected <br /> as confidential information by the Mined Land Reclamation Board and shall never be a matter of public record. <br /> Prospect Site Name: _��"�� _ Prospect NOI No.: P <br /> Drill Hole I.D. No. �- <br /> Date Drilled: 2'c i.� Date Permanently Abandoned: r� '-; ST �Cff <br /> OEERATOR: (PROSPECTOR) DRILLER: <br /> Name: '�� -'� �"f=~ — Name: <br /> A dress: j�,r' dI-r �r`J v!Y+�t Address C f „! <br /> St.: Zip:__, ec` City: 4 uk9 St.: ,'T �� Zip: <br /> Telephone No.: Telephone No.: ( CI Z `� - /ef/ <br /> LOCATION: <br /> The following information is required for all prospecting drill holes: <br /> G 1/4 of the w V4 of Section i `� Township "2 Range t�Pae <br /> !V M t s---�—Prime Meridian, M,,e. ^) County. <br /> If the area has not been surveyed,supply the Longitude_ _West and t.atitude _ North. <br /> or attach a location map. preferably a t"SciS Quad. <br /> The foili}wing additional init)r?7iatlon is required for ariessian FlcltLing holes: <br /> Di tance-s Mu,,i be r(rvided with art aCetxaeN of ._200 feet(34-32-1 13(5.5)(d)I <br /> feet north 0south from thetsouth Onorth section line <br /> feet 'ast 11west from the[]west east section line <br /> In the case of closely spaced drill holes having similar geologic and hydrologic characteristics,the Operator <br /> may,u ith the approval of the Divisioti.submit a single consolidated final report including the location ofall <br /> drill hole;,and a description of abandonimi-it technique- In such a case.complete one abandonment final <br /> report t�)rtrt and attach a list of drill bole !ccations. If more space is needed to pro, tdc any of the <br /> i ri.i�rl3tti_:t1t1 I it tl't i;; lC)ra'ri. please attach �,c ariltl=sheets. <br /> 016(e of tltncP c=1 <br /> wined land Re:I,:mr.;;,i 0-now.- _'s.,nd lunct,or • Durmgo cno h1.;CtroC Ali,e <br />