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.; <br />~ ~ ~ III IIIIIIIIIIIII III ~ <br />DIVISION OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS <br />Regular (112) Mining Operation <br />Application Worksheet/Checklist <br />New App: <br />Amendment App: <br />Conversion App: <br />Operator: ('~~+-(-e C01'N~.(P~ ~.h~ <br />Mine Name : ~,~I?i ~Q(111 ~'1 <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />Mine ID: m ~ ~ <br />Submittal Date: <br />ITEMS <br />COMPLETED 1 2 3 4 5 6' <br /> / v ` ~ / <br />ITEMS <br />COMPLETED 7 8 9 10 11 12 <br /> ~ / ,~ / / / <br />ITEMS CONV/AMEND PERMITEE SIG <br />COMPLETED DESCP RESP <br /> 1~2/ 3' <br /> 4.~/6/ / <br /> ~- Sr 9~ <br />MAPS and EXHIBITS (Rule 6.2) <br />ADEQUACY COMMENTS <br />EXHIBIT A -6 4.1 - LEGAL DESCRIPTION: / <br />