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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING ARID SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 RECEIVED <br /> Denver,Colorado 80203 <br /> Co 0RAD0 <br /> Phone:(303)866 3562 n i v i s t o rJ o f <br /> FAX:(303)832-8106 MAY 2 6 2021RECLAMATION <br /> M i N N�� <br /> DIVISION OF RECLAMATION SAFETY <br /> MINING AND SAFETY <br /> NOTICE OF INTENT TO CONDUCT EXPLORATION OPERATIONS <br /> TI•tis form is ftrr at]construction uc tion material niinierals. <br /> If you plan to conduct exploration on any lands in Colorado. then you must provide all information described in <br /> this form."Exploration" is defined in Rule 1.1(13)ofthe Construction Material Rules and Regulations and is <br /> discussed in greater detail in the " Exploration information" form. Each of these can be obtained from the office <br /> of-the Division of Reclamation.Mining and Safety(DRMS). If you plan to conduct exploration on Bureau of Land Management <br /> (BLM) land,you should also include the information on pages 5 and 6 of this form. <br /> All information provided the Mined Land Reclamation Board(MLRB)in this Notice of Intent will be protected as confidential <br /> information by the Board and not be a matter of public record in the absence of a written release from the Operator or upon a <br /> finding by the Board that reclamation is satisfactory. <br /> * Information on this form which is not required by law,but which.if provided,will assist the Board in timely processing <br /> and release of financial warranty obligations. <br /> I. DATE OF FILING OF-PHIS NO_fICF OF rN ENT: u m —_o�� _ Qc)q` <br /> 2. EXPLORER: PERSON MLRB SHOULD CONTACT: <br /> Name: C a5.c `-�Q ns Name: <br /> Address: 3c3c) V-Qg--n - *%j ,address: 2-k-) <br /> <<; Cry a _ ; l ,b n\ 1a <br /> Phone: -�Q() - C(:-:) �12 Phone: <br /> a(g o�so <br /> 3. APPLICATION FEE: $108.00 <br /> 4, DESCRIPTION OF THE LANDS: <br /> Site Name: <br /> Lvcatton fhe [and is tcscated printarily within *Section I ownship <br /> Rangy ...__.. . _-_ Pritme Meridian. kCountt. .....-_._.__.. <br /> NOTE: Supply longitude arld latitude if lands have not been surveyed: � <br /> *Land Ownership: Private .._._..__.._-----.............._.._-_._._._.....--_ and or Public(specify a`>ency) .._� . -..-,-------._.___-. <br /> Estimated <br /> I <br /> acreage of la»d tictrface to tk affected: — <br /> Please attach a I'SGS 7.5 rninute quad,or similar map of adequate scale. which locates the exploration sue(,), <br /> Office of Office of <br /> Mined Land Reclamation Denver Grand Junction • Durango Active,Ind Inactive Mines <br />