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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 C O L O R A D O <br /> Phone:(303186&3567 nI v t s r o w o r <br /> RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> — <br /> 5AE ETY <br /> EXPLORATION ON BUREAU OF LAND MANAGEMENT(FILM) LAND <br /> You must provide the following additional information. if you plan to conduct exploration operations on Bureau of Land <br /> Management(BI-M)land and wish to take advantage of the BL.MtMLRD Cooperative agreement. This information will allow <br /> the BLM and MLRB to minimize duplicative efforts and allow you to post only one financial warranty for your exploration <br /> operation. <br /> 1. CLAIMANT: <br /> Name: <br /> Address: <br /> Telephone: <br /> 2. SITE/CLAIM INFORMATION: <br /> List names.serial numbers and provide legal description to nearest quarter-quarter section of all sites or claims(attach <br /> additional page, if necessary). <br /> NAME SERIAL NUMBER LEGAL DESCRIPTION <br /> VA <br /> LOCATION ,MAP: y <br /> i <br /> Please attach a USGS 7.:minute quad_or similar map of adequate;tale, which locates the exploration sitets). <br /> a Are drill sites staked on the around'' Yes n xi(� NO �� ���r <br /> —l_J— I <br /> Office Of �— Office of <br /> Mined Land Reclamation Denver • Grand Junction a Durango Active and Inactive Mines <br /> i <br />