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~ [~ECE11/E~co ~l III IIIIIIIIIIIIIIII FEB 101987 999 MINED LAND LIMITED IMPACT OPERATION (110) RECLAMATION DIVISION APPLICATION FORM This form contains .two ma,)or parts: (1) General Operation Information and (2) Exhibits A-G. When you submit your application, be sure to include two ~~sl~yyned copies of the General Operation Information, two copies of Exhibits A-G, and aleck for the application fee described under (4) below. To expedite processing, please provide the information in the format and order described in this form. (-"1-`a 7 D~~ ----------------------------------------------------------------- GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/Operator Name: Rio Grande county 2. Operation Name (Pit, mine or site name): 374 Pit 3. Application type: Limited Impact Operation (110). 4. Application Fee (S10 x (affected acres) + E25.00).* n/a affected acres. Note affected acreage and application fee and attach a check for this amount when you file. n/a application fee. 5. Substance(s) to be mined (e.g., gold/silver/gravel): sand/Gravel 6. Owners(s) of Substance to be Mined (check applicable box(s)): ^ Private ^ State ^ Federal a Indian X County 7. Owner(s) of Record of Affected Land (check applicable box(s)): ^ Private ^ State ^ Federal ^ Indian X County 8. Type of Mining Operation (check applicable box(s)): ~ Surface ^ Underground ^ In-situ 9. Location Information. The center of the area where the ma,)ority of mining will occur lies in: COUNTY: Rio Grande PRINCIPLE c ec one 6th (Colorado) Xx 10th (New Mexico) Ute TOWNSHIP (write number and check direction): T 40 ~ North ^ South RANGE (write number and check direction): R ~- i8 East ^ West SECTION (write number): S QUARTER SECTION (check one): O-A~ ^ NW SE ^ SW QUARTER/QUARTER SECTION (check one): p NE ^ NW ~ SE !~ SW GENERAL DESCRIPTION: (miles and direction From Del Norte: 1 mile north on Colo. Hwy. 112 from nearest town and East 2 miles on Colo. Hwy. 374. approximate elevation) * If the operator is a unit of State or county government, an application fee 1s not required. A fraction of an acre must be counted as one acre for fee calculation.