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-3- <br />RECEIVE® <br />MAR f 8 2004 <br />10. Location information: The center of the area where the majority of mining wr71 occur lies is Division et Minerals end Geology <br />' COUNTY: L l G YU /{ t M It Q y <br />- C A S .v T Y <br />PRINCIPAL MERIDIAN (check one): ~ <br />6th (Colorado) _ 10th (New Mexico) _ Ute <br />SECTION (write number): S 17 <br /> <br />TOWNSI~ (write mmrber and check direction): T North ~Soath <br />RANGE (write number and check direction): R _ <br />^ East ~~est <br />QUARTERSECTION (check one): _ IVE _ NW / SE _ SW <br />QUARTFA/QUARTER SECTION (check onej: _ NE _ NW / SE _ SW , <br />GEA1ERl+I. DESCRiPTiON (miles and direction from nearest Iowa and approximate elevation); _y an r L R f <br />.~_ <br />A/ a Yl T iJ • Ai r (T i0 K T N .IG I J tl c .l w i w.i / < . n. r e ¢ f . ~ . G l1 n !n Q` <br />11. Primary future (Post-mininQl land use (check one): <br />Cmplaad(CR) Pastureland(PL) _ General Agricnltnre(GA) <br />_ Rangelaad(RL) ~ Forestry(FR} _ wildiite Aabifat(WL) <br />Residemial(RS) Recreauon(RC) h~crr:auCommercial(IC) <br />_ Devekoped wafer Resources(WR) _ solid waste Disposal(WD) <br />I2. Primary areseat kmad use !check ones: <br />_ Croplaad(CR) _ Pastureland(PL) _ General Agriculture(GA) <br />Rangeland(RL) _. Forestry(FR) i Wildlife Habitat(WL) <br />_ Resideatial(RS) _, RecceahianCRC) _ Indusarial/Commercial(IC} <br />_ Developed Water Resources(WR) ~ b8mng(MI~ <br />13. if this opendiaa w,1! use desgnafed chemicals, or will result, or presently has acid mim` acaiIIage - yeru eamtot nse this <br />application form. You must submit a either a l I0d or 1124 apolica6oa form for Designated Mining Operations. In either . <br />case, yon must list any acidic or toxic-fprming materials, exposed or disturbed as a msnlt of the mining operation, and <br />whetherxhe opemtioa will result in or presently Las acid mine diainage: <br />14. Descriptiioa of Conversion: Tf yon are converting an existing operation, pmvrde a brief narrative descrr'bing the proposed <br />change(s): ~ <br />15. Mans & Ezhrbi ts: Snbmit two f2) complete, ®bomd conies of the following application exhibits: <br />63.1 EXIIIBFT A -Legal Description and Location Map <br />631 EXI•IIBTT B -Site Description <br />6.3.3 EXIIIBTT C - Mraiag Plan <br />6:3.4 E~TT D -Reclamation Plan <br />6.3.5 E`~TTE-Map <br />6.3.6 EXI3IDTT F -List of Other Permits and lieen~s Required <br />63.? EYfIIBIT G - Source of Legai Right-fo-Emer <br />6.3.8 E7lIi~TT H - Municipalities wrrLin a Two-mile Radius <br />6.3.9 EI~TT I -Proof of Filing with County Cleric <br />6.3.10 EY731$TT J -Proof of Ma>7ing Notices ofPermit Applicatioal <br />6.4.19 EXIiIBIT S -.(as required} ~ '1 (~ <br />6.5 Geotechmcal Stability Exhrbit (as required) <br />