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<br />INSTRUCTIONS FOR COMPLETING OPERATORS CHANGE IN STATUS REPORT <br />MINE NUMBER Enter the number assigned by the Division o+ mines. <br />Leave thI^ line blank only If you have answered yes to 'IS THIS A <br />NEW OPERATION? and answer 'Will Permits be required?' section YES <br />or NO for Olessl and Explosives. <br />MINE OR OPERA~1'ION NAME:Enter the correct name o+ the mine, mill, <br />Quarry, project, etc. <br />OWNER and UPERA~rOR: Give the name, address, and phone number^ of <br />the legal OWNER and OPERATOR. <br />OWNERSHIP: Check type. of ownership Corporatlon,Partnersh~o or <br />Individwl. <br /><If Incorporated or partnership complete section ;:;<i <br />IL1st all Contractors complete ^ectlon yy1 <br />LOCATION OF OPERAT I.ON: Indicate the location o+ the proper t~,+ b~~ <br />1/4 Section , Section, township and Ranee. <br />COUN~IY NO:Leave blank to be completed b;v Division o+ Mines. <br />COUNTY NO.:Indlcate the name of the county 1n which the operation <br />!a located. <br />PERSON IPI CHARGE Enter the name, Telephone number, Address, end <br />Iltle of the local manager. <br />STATUS: Check thti word which Indicates the current 5l'ATUS of the <br />operation. Producing, Exploring, Developing, Abandoned, Idle ar <br />Rehabilitation. <br />KIND OF OPERATION: Check the K1nd or type o+ operation fn which <br />you are engaged. Mine, Surface M1ne, Placer, Mlll, Prep Plant, <br />Tunnel, Tourist or Mine k PIIII/Plant. <br />AVERAGE NUPIBER OF EPIPLOYEES: Enter the average number of <br />employees during the year. This +Igure should include those <br />employee^ engaged In assessment and development work as well as <br />other klnda of work for the Underground, Surface mono and <br />Surface Facility categories. <br />OPERA~IIUfI WILL DE CUNDUC~fED: Enter the expected number o+ CAY~S A <br />WEEK, HOURS A DAY and WEEKS A YEAR you will be operatina. <br />L1ST OF PRODUCTION:Check the principle products o+ your <br />operation. this applle^ to all properties. <br />SECfIUN lXX1:Complete thta section If eau have chec4ed the <br />ownership ^ectlon indicating that ownership 1s a Corporation or <br />Partnvrslilp. Leave blank l+ ownership la lndlvldual. <br />IF Incorporated indicate State where Incorporated. Enter the <br />names o+ the o+ticers of the corporation o+ partners on fife <br />lines provided. <br />SECfIUN YY SECONDARY CONTRACTOR'S: Enter the name o+ all <br />^econdarv contractors. <br />I4 more than t3lthree list on a ^eperate sheet o+ paper and <br />attach to this document. L1st name, address, zip code and <br />Telephone number for each contractor. <br />• <br />COLORADO DIVISION OF h11NES <br />1313 Sherman Street <br />Denver, Colorado 80203 <br />DEC 1 p 19gp <br />