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PLAN OF OPERATIONS FOR MINING ACTIVITIES FS-2800 5(Rev 12111) <br /> USDA,Forest Service ON NATIONAL FOREST SYSTEM LANDS <br /> OMB NO 0596-0022 <br /> USE OF THIS FORM IS OPTIONAL! TIME USERS SHOULD DIRECT QUESTIONS REGARDING THIS FORM OR <br /> REGULATIONS(36 CFR 228A)TO THE FOREST SERVICE DISTRICT OFFICE NEAREST YOUR AREA OF INTEREST. <br /> Submitted by: <br /> Signature • Title Date <br /> (mm/dd/yy) <br /> Signature Title Date <br /> (mm/dd/yy) <br /> Plan Received by: <br /> Signature Title Date <br /> (mm/dd/yy) <br /> I. GENERAL INFORMATION <br /> A. Name of Mine/Project: <br /> B. Type of Operation: <br /> (lode,placer,mill,exploration,development,production,other) <br /> C. Is this a(❑new/❑continuing)operation? (check one). <br /> If continuing a previous operation,this plan(❑replaces/❑modifies/❑supplements)a previous plan of <br /> operations. (check one) <br /> D. Proposed start-up date(mm/dd/yy)of operation: <br /> E. Expected total duration of this operation: <br /> F. If seasonal,expected date(mm/dd/yy)of annual reclamation/stabilization close out: <br /> G Expected date(mm/dd/yy)for completion of all required reclamation: <br /> II. PRINCIPALS <br /> A. Name,address and phone number of operator: <br /> B. Name, address,and phone number of authorized field representative(if other than the operator). <br /> Attach authorization to act on behalf of operator. <br /> C. Name,address and phone number of owners of the claims(if different than the operator): <br /> (If more space is needed to fill out a block of information,use additional sheets and attach form) <br /> -1- <br />