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FpRESr 5iitvq <br />US NOTICE OF INTENT I `'SFS SOUTH PARK RANGER DISTRICT <br />FOR MINING ACTIVITIES I Date ReceBved:^— <br />fta1°` Pursuant to 36 CFR 228 <br />Receive=_ <br />15-day Response Date; �` <br />(Use of thisform is optionai) <br />I/We, �!�� .r Q — <br />declare my.�our intent to nduct inning operatio n unpatented��N�Forest System Land's withinrhe outh[ <br />. <br />Park Ranger District of the Pike National Forest, This mining activity u III !je in the form(s) of <br />v /`Yrospectilg, Exploration, Dev opment or Productions <br />Name Cdl rr <br />Phone Number <br />Mailing Address: /JZ7 j1_„r <br />City -e <br />Email - <br />Claim # <br />Surface dis <br />State: D Zip Code. t / <br />Claim Name Township Range Quarter <br />(North or (East or Section(s) Section <br />South) West) (NE. SE, <br />SW. v%) <br />Cius, pits, trenches, drilling, shafts <br />Reclamation Plan; <br />11 be in a fo of: s <br />cirtting rust± c oii.,trrtcttvn, tailings deposit, <br />g etc. <br />Estimated Acres of Disturbance: <br />/WV f <br />�� 4 ,J�rd��itl►,, <br />S,ocr... a r� A <br />Work will be implemented by.111��� J <br />peri/i handwork, it, f tool and or ma hinery, etc I <br />Travel to the operation(s) will be by. � �j�% e oC <br />s �� � F✓` /O �/.r . <br />Sped OPe of vehic•le,.foot travel, anunal, etc <br />Owners of claims other than operator. 1 <br />_ 1 Arm✓� / _ � / � � f �I <br />List names and addresses of individuals, companies, etc. <br />Proposed start-up date and duration of mining activities (mm/dd/vy, : f 7p�,. <br />-7/ Z al,� <br />SIGNATURE OF OPERATOR(S): <br />(nurr,ildlvt') <br />•• 4 Plan v O arions ,l <br />f pe (form Fs -_800-,i/ well he required for all activitip.r that io valve nrachinert uec frlhng, +vud rarrstrucuon. a+rd other <br />at•uvdics that cause significant disturhmrce (36 LFR 228'4) <br />ATTACH MAP TO NOTICE: Map must show mining claim, both road and off-road access to work <br />site, Road access is shown in BLACK, off-road access is shown in BLUE, and proposed road and/or trail <br />construction is shown in RED. <br />