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• III IIIIIII9~~u~m ~ ~~~~~~~~ ~, .- . h1AR 181988 MINED LAND LIMITED IMPACT OPERATION (110) ~7ECLAMATION OIVISIO~~ APPLICATION FORM This form contains two major parts: (1) General Operation Information and (2) Exhibits A-G. When you submit your application, be sure to include two ~signed 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__~_~~_ ~~ t_ GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/Operator Name: ~~. ~GX~Atl~f~~Enl 2. Operation Name (Pit, mine or site name): ~c~~g,ef iQg„~/ CRguc/. 0';7~ 3. Application type: Limited Impact Operation (110). 4. Application Fee for Permitted Acreage* S permitted acres. (E10 ~: (affected acres) + E25,00).* Note permitted acreage and application fee and attach a check for this amount when you file. ~~] S, DD application fee. 5. Substance(s) to be mined (e. g., gold/silver/gravel): ~j.~,v~ sln~d GRAl~z,L . 6. Owners(s) of Substance to be Mined / (check applicable box(s)): ~ Private ^ State ^ Federal ^ Indian 7. Owner(s) of Record of Affected Land (check applicable box(s)): Q Private ^ State ^ Federal ^ Indian 8. Type of Mining Operation J (check applicable box(s)): Gd Surface ^ Underground ^ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: ~f,'N~,~~ ~ PRINCIPLE MERIDIAN check one ^ 5th (Colorado) Q'lOth (New ^lexico)^ Ute TOWNSHIP (write number and check direction): T ~/D p~tJorth ^ South RANGE (write number and check direction): R 1- ^ East L~West SECTION (write number): S QUARTER SECTION (check one): p'~ ^ NW ^J SE ^ SW QUARTER/QUARTER SECTION (check one): ~_ NE ^ NW (17 SE ", SW GENERAL DESCRIPTION: (miles and direction /'.f/n, ~!v .~/ ~,ee~o/.. (ro,lo, from nearest town and approximate elevation) P~i•,r~ov ~~df> * If the operator is a unit of State or county government, an application fee is not required. .4 fraction of an acre must be counted as one acre for fee calculation.