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<br /> <br />R ~cnara D Lamm <br />Go•ernor <br />DEPARTMENT OFNATURALRESOURCES <br />D Monre Pascoe. Eaecuu.e Duecror <br />MINED LAND RECLAMATION DI <br />DAVID C. SHELTON, Director <br />This report is filed in accordance with Rule 4.07.3(3) of the Regulations of <br />the Colorado Mined Land Reclamation Board for Coal Mining, adopted in <br />accordance with the Colorado Surface Coal Mining Act, C.R.S. 34-33-10T et seg. <br />This report is to be submitted within 60 days of sealing and plugging o~a1T <br />drill holes approved under the specific drilling program. This report can be <br />used for single or multiple holes and can be modified as needed, provided that <br />the information contained in Rule 4.07.3(3) is supplied. Additional sheets <br />may be attached, if necessary. <br />Prospector: <br />~j C p~ CcJ c.l \ C J :.~~ 1~ v ,~ <br />~ ~ <br />Address: ~vKU=~~ <br />Notice of Intent No.: ~~ry County: (Coop.. <br />Project Name: ~n-~u~E'v Meh.~uv ~e~~ ~ ~c~...~C~hw.ov:~s ~~~~ <br />Date: ~ Z - S ' ~ [~ <br />Name of Drilling Contractor: <br />License of Drill and Rig: <br />(Continued on Next Page) <br />(Rev. 5/83) <br />Doc. No. 3018 <br />423 Centennial Building, 7313 Sherman Streel Denver, Colorado 80203 Tel. (303) 866-3567 <br />