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i • <br /> 4 (Fortn g) <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 /> IF F <br /> '0 ,S : �e�"lt `?>� in i U <br /> (JhCj <br /> W t (.Jt (ice <br /> 6. Proposed Disturbance(approximate)Describe the proposed drilling to be conducted,including anticipated number of holes, <br /> diameter,depth,location,etc... Submit additional pages if necessary: <br /> A. Drill Pads: Quantity Average Width (ft)Average Length (ft) <br /> B.- Drill Holes:Quantity Depth (ft) Diameter, (in) <br /> C. �fvt'ad it'it;5 Qulantity— --,Average Width � (ft)Average Length `� (ft) <br /> Average Depth.ja S' i/1iC41tS ( tp, <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 /> i is � - / . <br /> `S !-o cam: <br /> t � � t0 b#o Q i 61 �cpz�W t?o�p i <br /> D. then Disturbances Q(plas'U�dPIIQ <br /> a a r LJt ' <br /> E. Indicate Chemicals and Fuels used or stored on site. List type,quantity and method to store. <br /> t <br /> F. New Road(s): Length (ft)Width (ft) <br /> Significantly Upgraded Road(s) Length (ft)Width (ft) <br /> Are culverts or other crossings proposed? If o,please describe: <br />