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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> oeparmt-ant()i No-u d Resourr r, <br /> i Sturm..,n St,Room_t i <br /> Ct O L OMR A D O <br /> Denvt�r,Colorado Bu20 i U V p F <br /> Phone:,101' Stt-! 6' IONCLA <br /> F,kX-3o-;;n 2-H1oe MINING <br /> RF SAFETY <br /> IVEp <br /> MINERAL PROSPECTING DRILI. HOLE AUG 092017 <br /> %7PERMANE.NT ABANDONMENT FINAL REPORT DMS/ONpFREC <br /> AWING AND SAFE6ION <br /> Pursuant to the terms of 34-32-113(5.5)(d)and(e)of the Act,all information provided in this report shall be protected <br /> as confidential information by the Mined LLand Reclamation Board and shall never be a matter of public record. <br /> Prospect Site Name b _ �/ 1^L�'� Mai- <br /> - Prospect NOI No.: P_�_Q <br /> Drill Mole I.D. No. _ h <br /> Date Drilled: _- .. _-_ Date Permanently Abandoned: V - <br /> OPERATOR: (PROSPECTOR) DRILLER: _ <br /> Name: C`�G c N N LL L Name: J via L Lc <br /> Address:- S c:`L 1-� ��i�j C i N -S'� Address:— S( ��A ° --_ -— <br /> City: ��N N icj0^1 _—St.: (b zip:_b 1 �Z�U City: /- O St.: C G zi :�( 3 <br /> Telephone No.: (' ) tf -�l Telephone No.: (910 ),4 <br /> LOCATION: <br /> The following information is required for all prospecting drill holes: <br /> S 1/4 of the _5 1.'4 of Section Township. , Range <br /> L%� Pnme Meridian, �` �''�'��� tj County. <br /> If the area has not been surveyed,supply the Longitude___-,--,--„---.,-,-..West and Latitude -.-.---- North. <br /> or attach a location map, preferably-a t;SGS Quad. <br /> The following additional intormation is required for artesian flawing hales: <br /> Distances trust be rav'ded with an accuracy of Q00 feet(34-32-1 13(5.5)(d)) <br /> --------------------feet Unorth Usouth from thellsouth Onorth section line <br /> feet Dast west from the[]west east section line <br /> NnTE: In the case of closely spaced drill holes having similar geologic and hydrologic characteristics,the Operator <br /> may,with the approval of the Division.submit a single consolidated final report including the location ofall <br /> drill holes and a description of abandonment technique. In such a case.complete one abandonment final <br /> repeat form and attach a list of drill hole locations. If more space is needed to provide any of the <br /> mformation for this, torm, please attach separate sheets, <br /> 011ice,o (11ntt (A <br /> 'timed Land Rea Iotn„noo Oen%or - Grand lunettor • Dur.trtgo 1 tive,wo Irwetroe•Mats,-, <br />