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4 (Form 1. - All information for DBMS use and confidential filing) <br />5. Describe proposed surface excavation or other land disturbance, including roads, pits, trenches, waste piles, drill pads and <br />collar areas of underground workings, ponds, etc... <br />/l% �/2Grl �DLrc✓ Cary s�i -drih Sri . f'� `�/�ieh f /, li 6 P ''�,/� /.12 P �iI " �-,7 4 -ems -t� 'b <br />ro�c�s • Each �xc�vg�iy.� �✓.' / /6�PP`' /i� °° ' �cc�A� Sift �5� c��. <br />G /Gi.77i2d ylec2/ P�SOPcI�S.i?'s_ <br />6. Proposed Disturbance (approximate) Describe the proposed drilling to be conducted, including anticipated number of holes, <br />diameter, depth, ration, etc... Submit additional pages if necessary: <br />/lt° A. Drill Pads: Quantity Average Width (ft) Average Length (ft) <br />141an of B. Drill Holes: Quantity Depth (ft) Diameter (in) <br />/j/'v4 eC. 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, rock dumps, or other types of disturbance, describe type, quantity and general dimensions: <br />D. Other Disturbances (please describe): <br />E. Indicate Chemicals and Fuels used or stored on site. List type, quantity and method to store. <br />F. New Road(s): /l� °�% Length (ft) Width _ <br />Significantly Upgraded Road(s) Length (ft) Width <br />Are culverts or other crossings proposed? If so, please describe: <br />(ft) <br />----- (ft) <br />