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COLORADO CULTURAL RESOURCE SURVEY <br />Management Data Form <br />OAHP1400 <br />Rev. 11/10 <br />A Management Data Form should be completed for each cultural resource recorded during an archaeological survey. <br />Isolated finds and revisits are the exception and they do not require a Management Data Form. Please attach the <br />appropriate component forms and use continuation pages if necessary. Fields can be expanded or compressed as <br />necessary. <br />1. Resource Number: <br />3. Attachments (check as many as apply) <br />® Prehistoric Archaeological Component <br />❑ Historic Archaeological Component <br />❑ Linear Compojnent <br />® Sketch/Instrument Map (required) <br />® U.S.G.S. Map Photocopy (required) <br />® Photograph(s) (required) <br />❑ Other, specify: <br />I. IDENTIFICATION <br />5. Resource Name: None <br />2. Temporary Resource Number: BK -1-072617 <br />4. Official determination (OAHP use only) <br />❑ Determined Eligible NR\SR <br />❑ Determined Not Eligible NR\SR <br />❑ Nominated <br />❑ Need Data NR\SR <br />❑ Contributing to NR Dist.\SR Dist. <br />❑ Not Contributing to NR Dist.\SR Dist. <br />❑ Supports overall linear eligibility NR\SR <br />❑ Does not support overall linear eligibility NR\SR <br />6. Project Name/Number: Collom Expansion Cultural Resource Monitoring <br />7. Government Involvement: ❑ Local ® State ❑Federal <br />Agency: Colorado Department of Mining and Reclamation <br />8. Site Categories (check as many as apply): <br />Prehistoric: ® archaeological site ❑ paleontological site ❑ In existing National Register District <br />National Register District name: None <br />Historic: ❑ archaeology site ❑ building(s) ❑structure(s) ❑ object(s) ❑ In existing National Register District <br />National Register District name: None <br />9. Owner(s) Name and Address: Colowyo Mining Company <br />10. Boundary Description and Justification: Site dimensions are based on the observed extent of the exposed <br />features and artifact scatter within the haul road cut. No surface manifestation of the site was present prior to topsoil <br />disturbance; therefore the current boundary may not represent full horizontal extent of the cultural manifestation within <br />remaining intact portions of the disturbance area. <br />11. Site/Property Dimensions Length: 50m Width: 25m Area: 981M2 Acres (M2/4047):0.31 <br />Area was calculated as: ❑ Length x Width (rectangle/square) ® Length x Width x 0.785 (Ellipse) ❑ GIS <br />II. LOCATION <br />12. Legal Location <br />PM 6th Township 4N Range 93W Section 21 NE % NE % <br />PM Township Range Section _ % % <br />PM Township Range Section _ % % <br />PM Township Range Section _ _ % _ % <br />If section is irregular, explain alignment method: <br />13. USGS Quad: Axial, CO 14. County: Moffat <br />(Page 1 of 5) <br />