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FROM :LISPS YODER CO 80864 FRX N0. :7194783161 Rpr. 01 2005 02:10PM P2 <br />RECEfVEI~ <br />7 <br />8. <br />9. <br />10• <br />I1 <br />12. <br />1 13. <br />1 14. <br />-3- <br />sine of owner Qf the subsuc[ace ri2hta of affected land: <br />III-S1N <br />~pR O1 SOUS <br />~~ <br />PRINCIPAL MERIDIAN (check one): ~ th (Coloraa) 10th (New Metdco) Ute ~" n <br />SECTION (write number): S ~~ <br />TOWNSHIP (write ntmtber sad check direction): T ~_ Nott}t _ `~' ,South <br />RANGE (write nttmber and check direction): R ~ East ~ West ~ '~~ <br />~ ~ <br />QUARTER SECTION (check one): NE Nw SE . <br />~ <br />_J[SW <br />Name of ovroer of the aurPaeo of s} fected land; ~j L GGVi• S~C~f ; <br />Tune of mintne operatton: ~~ Surface Underglrnmd _ <br />location information: The c,~er of the asra where the majority of mining wiU occm•: <br />COUNTY: <br />QUARTERlQUARTIIt SECTION (check one): _~[_ NE Nw 3E SW <br />GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approxuasu elevation): <br />Primerv Mine Entrance Location (report in either Latirude/Longitude or UTM): ~- ~.g7,` <br />Lstltude/I.ongltude ~/ <br />Latitude (1V): deg min sec OR Latitude (Al) ~J~•~/39~p/4~ decimal places) <br />Longitude(W)~ deg tt;in sec Longiu:dc(JJ) ~,1~~2~~,5decimalplaces) <br />Universal Trsnyerxe Mercator tT1TM1 <br />UTM Datum (specify NAD27, NAD83 m WGS 84) Zone <br />x~ting <br />Eastiug <br />Primarv fltture tPost-miniaQl land use (check onel: <br />Cropland(CR) _ Pastureland(PL) _ General Agricultttrr.(GA) <br />RanBeland(RI-) _. FavestrY(FR) _,._ Wildlife Habitat(VJS.) <br />Residmtial(RS) _ Recrration(RC) _ IndustriaVCeanmccial(IC) <br />" Developed waterReaotirces(WR) __._ Solid WasteDisposal(VJD) <br />Primary present Land nae (check onel: <br />_ Cropland(CR) ,_ Pesttvelead(PL) _ Creneral Agtiailture(GA) <br />Rangeland(RI.) _ Farestry(PR) _ Wildlife liehitat(WI,) <br />- ResidetttialtRS) _, Recreation(12C} ~ IndustrieUCommercial¢C) <br />_ Developed Water Resources (WR) _ Mining (NIIV) <br />If this operation will ute designated chemicals, or will result, or preswtty has acid mice dreiuage -you cannot use this application form. <br />You must submit either a 1104 or 1124 application form for Desigasrted Mining Opesatioffi. In either case, you must list any acidic ar <br />toxio-foruting materials, exposed or disturbed es a result of the mining operation, and whether the operation will result in orpr~ertlyhax <br />acid mine drainage: <br />e /_ ^ <br />