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STATE OF COLORADO <br /> DIVISION Of RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 <br /> COLORADO <br /> Denver,Colorado 80203 n i v i s tor+ o r <br /> Phone:6031 866-3567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> --�SAFETY <br /> EXPLORATION ON BUREAU OF LAND MANAGEMENT(BLM)LANIT <br /> You must provide the following additional information. if you plan to conduct exploration operations on Bureau of Land <br /> Management(BL.M)land and wish to take advantage of the BLM%MLRD Cooperative agreement. This information will allow <br /> the BLM and MLRB to minimize duplicative efforts and allow you to post only one financial warranty for your exploration <br /> operation. <br /> I. CLAIMANT: <br /> Name: <br /> Address: <br /> Telephone: <br /> 2. SITE/CLAIM INFORMATION: <br /> List names.serial numbers and provide legal description to nearest quarter-quarter section ofall sites or claims(attach <br /> additional page, if necessary). <br /> NAME SERIAL NUMBER LEGAL.DESCRIPTION <br /> _..-_..._._................................_.-......_...._......._................._........_.._..-._...-_......____.__...__.__..-,_.___—_._-------.__.____._.......__-.........-......................_..--.........._...._........._......._,...............-._.._.._ <br /> I <br /> i <br /> F€c <br /> t <br /> ?. LOCATION MAP: z <br /> x: <br /> Please anach a U'SGS 7.S minute quad. or,similar snap of adequate cale, which locates the C ploration Suers). <br /> 1 4rc°Ciri{? ;iCr:;Staked or,the zriitttlu-' 'Yes No _..... <br /> Office of <br /> office of <br /> Mined Land Reclamation Denver • Grand junction Durango Active and Inactive Mines <br />