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6. <br />7. <br />8. <br />9. <br />-2- <br />Name of owner of the -tubsurfam rights of dLeqkd land: <br />Name of owner of themrfm of affected land: <br />Tyne of mining onerstioa: L Surface -Wound _ <br />lilocation information: The of the area where the majority of mining will occur: <br />COUNTY: E U ?P,11. %C3 <br />PRINCIPAL MERIDIAN (check one): 6th (Colorado) <br />SECTION (write number): S i <br />TOWNSHIP (write number and check direction): T 1 + <br />RANGE (write number and check direction): R <br />In -situ <br />10th (New Mexico) Ute <br />North South <br />FROM= <br />QUARTER SECTION (chock one): NE NW <br />QUARTER/QUARTER SECTION (check one): NE NW <br />West <br />SE <br />SE <br />GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): <br />10. Primary &WE (Post-minina) land use (check one): <br />_ Cropland(CR) __.. Pastureland(PL) <br />Rangelanm) -.-_ Forestry(FR) <br />_ Residential(RS) _ Recreation(RC) <br />Developed water Resoaroes(WR) <br />11. Primary areseat land—My (check one): <br />_ Croplatd(CR) _ Pastumland(PL) <br />Rangeland(RI.) _ Forestry(FR) <br />Residential(RS) — Recreation(RC) <br />Developed Water Resources (WR) <br />General Agriculture(GA) <br />_ Wildlife Habitat(WL) <br />Indus"Commercial(IC) <br />Solid Waste Disposal(WD) <br />— General Agriculture(GA) <br />,_,_ -_ Wildlife Habitat(WL) <br />Iadustrial/Commercial(IC) <br />Mpg (MN) <br />SW <br />SW <br />12. If this operation will use designated chemicals, or will result, or presently has acid mine drainage - you nmt use this application <br />form. You must submit either a 110d or 112d application form for Designated Mining Operations. In either case, you must list any <br />acidic or toxic - forming materials, exposed or disturbed as a result of the alining operation, and whether the operation will result in or <br />presently has acid mine drainage: <br />",rRtXE w <« l3� No 4C-1 61r. a,c Tox c - FOMM,Wr. Nti4r us Gsc s�1 s <br />5 PeJr.4r10wf • F Pt.sY Nlutr a,tn.t -% 1V&l <br />4S D&Sealaeb trJ C. IM�*lr�r�r R.'t►.� <br />13. Jkscrbtion of Amendment or Co�ersion: <br />If you are amending or converting an existing operation, provide a briiejfnarrative describing the proposed change(s): <br />