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I ~ • • • 2 6. Name of owner of the subsurface rights of affected land: JOSEPH L. and ARLENE COGAN 7, Name of owner of the surface of affected land: SAME TENANTS IN COMMON 7.1 Names of the holders of any recorded easements on the affected land: ~0 EASEMENTS 8. Rboe of mining ooeration: X Surface Underground ~ In-situ 9. Location information: The center of the area where the majority of mining will occur: COUNTY: CNAFFFR PRINCIPAL MERIDIAN (check one): X 6th (Colorado) 10th (New Mexico) Ute SECTION (write number) : SEE ATTACHED TAX RECEIPTS S TOWNSHIP (write number and check direction): T ~_ North South RANGE (write number and check direction): QUARTER SECTION (check one): R ~_ East West NE NW ~ SE SW QUARTER/QUARTER SECTION (check one): NE NW SE SW GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation) : STX MTT~F.S SOTTTHF.AST OF RTTFNA VISTAS COLORADO APPR(1XTMATF.T.\' 7ROO FF.FT 10. Pr+T~*+~ future (Post-mining) land use (check one): _ Cropland(CR) Pastureland(PL) General Agriculture(GA) ~ Rangeland(RL) Forestry(FR) Wildlife Habitat(WL) _ Residential(RS) Recreation(RC) Industrial/Commercial(IC) _ Developed Water Resources(WR) Solid Waste Disposal (W D) 11. Pr++~~++~ vresent land use (check one) : Cropland(CR) Pastureland(PL) General Agriculture(GA) ,~ Rangeland(RL) Forestry(FR) Wildlife Habitat(WL) Residential(RS) Recreation(RC) Industrial/Commercial(IC) Developed Water Resources (WR) Mining (MN) 12. If this operation will use designated chemicals, or will result, or presently has acid mine drainage - you cannot use this application form. You must submit either a 110d or 112d application form for Designated Mining Operations. In either case, you must list any acidic or toxic-forming materials, exposed or disturbed as a result of the mining operation, and whether the operation will result in or presently has acid mine drainage: NO TORT MATFRTAT S 13. Descriotion of Amendment or Conversion: If you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s):