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<br />BECK ONE <br /> <br />LIMITED IMPACT OPERATION Ci10(2)) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />New Application (Rule 3.2) Amendment App}1catlon (Rule 1.8) <br />_ Conversion Appl'icatlon (Rule 1.10) <br />~e applicatton for a limited Impact Operatton Reclamation Permit contains three major <br />arts: (1) the application form; (2) Exhibits A-J; and, (3) the application fee. When <br />w submit your applicatton, be sure to include one (1) signed original and one C1) copy <br />the application form, two (2) copies of Exhibits A-J, and a check for the application <br />~e described under C3) below. To expedite processing, please provide the information <br />i the format and order described in this form. <br />:e.azzza_zaezzzzaaazazaazaazaaaaasaazzaazzaazaaazaaazzzaazzaazzaaazaazzaazaaazaaavazaaaa <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />.aaaaaazaaazzzavaaazaazaaaaaaazaazaazzaazzzaaaszazzavaaazaaaaazazaeaaavazazzaaaasaazaaaa <br />Applicant/operator name: _ ~/~(•lM TES Cci~^StR <br />1.1 Type of organization (corporation, partnership, etc.): ~='t/`~ <br />Operation name (pit, mine or site name): ~-7T ne^ ~ f'-' <br />2.1 I.R.S. Tax ID No. or Social Security No.: ~~/-//~~~/P/ (/ ~.ip~4 ~`'' <br />Permitted acreage U permitted acres°'q~lll{/fF~w-~l <br />3.1 Application Fee (New Application Only) <br />Substance(s) to be mined (e.g., gravel/gold/borro~> <br />Name of owner of surface of affected land: <br />Name of owner of subsurface rights of affected land <br />Type of mining operation: YSurface _ Underground <br />5875.00 application fee <br />CAHb cl <br />~/'i^~ / l~r7nR <br />_ In-situ <br />Location information. The center of the area Where the majority of mining will <br />occur lies in: <br />COUNTY: ,SfFti'h,~ry„~! <br />PRINCIPAL MERIDIAN (check one): 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction ): T ~ North South <br />RANGE (write number and check direction): , <br />R ~• East West <br />SECTION (write number): S ~ _ <br /> <br />QUARTER SECTION (check one): , <br />NE <br />NW <br />SE <br />SW <br />QUARTER/QUARTER SECTION (check one): _ <br />NE _ <br />_ <br />NW SE _ <br />SW <br />GENERAL DESCRIPTION: _ _ <br />~, _ <br />(miles and direction ~~ ~Ylr/P <:E•rl~.~y~2~7 ~ ~ <br />~p r~n;rz ~r1, ~n <br />from nearest town and <br />approximate elevation) ~~~ ~~5/r)PJ~,y/er ~ / ~ of <br /> <br />•L2ectr(:/z.l~J <br />/Du:'/L=17,~~'S~ n <br />/Ln~t<~,C-/~_ <br />