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-2- 6. Name of owner of the subsurface riehts of affected land: Mary Belle Raf err 7. Name of owner of the surface of affected land: Mary Belle Raf err 8. Tvue of minute operation: x Surface Underground In-situ 9. Location information: The enter of the area where the majority of mining will occur: COUNTY: Phi 11 i o S PRINCIPAL MERIDIAN (check one): x 6th (Colorado) 10th (New Mexico) Ute SECTION (write number): S ~_ TOWNSHQ' (write number and check direction): T ~_ x North South RANGE (write number and check direction): R 43 East x West QUARTER SECTION {check one): QUARTER/QUARTER SECTION {check one): NE x NW SE NE NW X SE SW SW GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): ~cm H~lvoke - 7 mi. East on U. S. 6; 2 mi. N, on CR 53; 1/2 mi. Eon CR 26; 1/2 mi. N to Pit -Approx. elev. - 3640 ]0. Primary future (Poet-mininel land nee (check one x Crapland(CR) _ Pastureland(PL) _ Rangeland(RL) _ Forestry(FR) Residential(RS) _ Recreation(RC) _ Developed Water Resources(WR) 1 I. Prhnarv present land use (check one x Cropland(CR} _ Pastureland(PL} _ Rangeland(RL) _ Fores[ry(FR) _ Residential(RS} _ Recreafion(RC) _ Developed Water Resources (WR) _ General Agriculture(GA) _ Wildlife Habitat(WL) _ IndusuiaUCommercial(TC) _ Solid WasteDisposal(WD) General Agricuiture(GA) WildlifeHabitat(WL) _ IndushiaUCommercial(IC} - Mining (MM 12. If this operation will use designated chemicals, ar will result, or presently has acid mine drainage -you cannot use this application form You must submit either a ] 1 Od or 112d applicalion form for Designated Mining Operations. In either case, you must hs[ a~ acidic ortoxic-forming materials, eacposed or disturbed as a result of the training operation, and whether the operation will insult in oa presently has acid mine drainage: 13. I)escr~ption of Amendment or Conversion: Tf you are amending or converting an existing operatioq Provide a brief narrative describing the proposed change(s):