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-M STATE of COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY _ <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 , iv t C <br /> Denver,Colorado 80203 C O L O R A D O <br /> Phone:(303)866-3567 n i v t s t o n OF <br /> FAX:(303)832.8106 /�W 0 .J � RECLAMATION <br /> MINING <br /> DIVISION OF RECLAMATION SAFETY <br /> MINING AND SAFETY <br /> NOTICE OF INTENT TO CONDUCT EXPLORATION OPERATIONS <br /> nis lorttm is firr all constructic,n material niffi tals. DI��SiOv <br /> If you plan to <br /> duct <br /> n any <br /> s in <br /> orado.then you must provide <br /> information descrig <br /> this form."Exploration"ation"is defined ploration(in Rule 1.1(13)oflthe Construction Materrial Rulesland Regulations and is ANO SA F�7-Y <br /> discussed in greater detail in the"Exploration Information" form. Each ofthese can be obtained from the office <br /> ofthe Division of Reclamation.Mining and Safety(DRMS). I fyou plan to conduct exploration on Bureau of Land Management <br /> (BLM)land,you should also include the information on pages 5 and 6 of this form. <br /> All information provided the Mined Land Reclamation Board(MLRB)in this Notice oflntent will be protected as confidential <br /> information by the Board and not be a matter of public record in the absence of a written release from the Operator or upon a <br /> finding by the Board that reclamation is satisfactory. <br /> * Information on this form which is not required by lave.but which.if provided,will assist the Board in timely processing <br /> and release of financial warranty obligations. (f <br /> 1. DA-i'E OF FILING OF'I'HIS NOTICE OF IN-TENT: _!._. . _ 4. <br /> 2. EXPLORER: PERSON MLRB1 SHOULD CONTACT: <br /> Name: (� (1 j; Name: <br /> Address: Address: Q!- <br /> y npr t 4fr p . CD faSra3 <br /> _ ------- - - -- - - ------------ --- ------- ------- - - -------------------- <br /> Phone: 41T-0- 00 Phone: 70 4T(— 0 It <br /> 3_ APPIACATION FEE.: $108.00 <br /> 4. DESCRI_f?: ION OF TE#c.fi:r�s1�i[7S: _ <br /> sit: �arlle ......�,.L- in....._. .�C... �- <br /> I_ocatrcn: I'he land is Iocatcd prirnarily within*Section p <br /> Rangt: _,__-_............................... • --------------------.--.._...-----------Prime Meridi t.n. *County ....._._____.____. <br /> NOTE: Supply longitude and latitude if lands have not been surveyed: <br /> *L_and Ownership: Private 1 ,andtor Public(speciA agency) ---------------------------------------- <br /> E;strina.ted acreage of land surface it)bt afi'ected: <br /> 1_ ....._ _ --....._ ..._.. <br /> Pleat-,e anach a I�SGS '.S rnin(tte:quad, or similar rsap of adequate Salle. v<hich lccaw,the -\ploration Site;<)_ <br /> i <br /> Office of Office of _ <br /> Mined Land Reclamation Denver Grand Junction Durango Act;ve and Inactive Mines <br />