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~~ 1 ~' / ~ <br />M~ 1,000 _~~~,/ , ' ~ RECEIVED <br />IIARn Rocl;;rnrETAL lvllrmvG~--- APR Z 1 ZOtl6 L____a <br />REGULAR OPERATION (112) <br />RECLAMATION PERMIT APPLICATION FORM Division of Minerals and Geology <br />CHECKONE:~NewApplication(RulelA.S) _AtttendmentApplicarion(Rule1.10) _ConversionApplication(Rulet.ll) <br />Permit # M- ~ - - (provide far amendments and conversions of existing permits) <br />The application far a Regular Operation Reclamation Pemdt contains thrcemajor parts: { I} the application fomt; (2} Exldbits A-S, Gcotectvtical 56i6ilityExhibit <br />and Addendum 1; end, ~(3) the application ter. When you submit your applicarion,besure to inciudc one (1) completed, signed and notarized grayoriginal and <br />four (4) copies ofthecampleted application form, five (5) copies of Exhibits A-S and the Geotechnicat Stability Exhibit, and Addendum 1, and n check far the <br />application fee descrilxd under Section 4 below. Exhibits should NOT 6c hound or in a 3-ring Mader; maps should be folded to S ~" X 1 l " or S 2" X 14" siu. <br />To expedite procession, plrase provide the infotrnation in fhe formaz and order descrihed in this form. <br />I GENERAL OPERATION IlYFORMATION <br />Type or print clearly, io the apace provided, all (nformarion described below. <br />I. Ap <br />1.1 <br />1.2 <br />2. Op <br />3. Pei <br />3.1 <br />3,2 <br />Fees: <br />4,1 <br />4.2 <br />43 <br />4.4 <br />4.5 <br />pe of organization (corporation, partnership, etc.): L l M l t lirt~ L 114 ~l L 1 T`"; c o~ , <br />~S.TaxI.D.No.: Z©-4209 - (31 <br />Dame (ptt, mitre or site name): ~ LF~D E Quilt' CZ~~' <br />~d acreage (new or existing site): <br />Change in acreage (+ or -) <br />Total acreage in Petttdt area <br />New Application <br />New Quan}'Applicadnn <br />Milling Application(Non-DMO) <br />Amendment Fee <br />Conversion to 112 operation (set by statute} <br />g'lo • 2- pemritted acns <br />~~ <br />acres <br />~(o r7i acres <br />51.875.00 application fee <br />52.325.D0 gvarryapplication <br />~3-lOD.00 milling application <br />1 550.00 amendmntt fa <br />$1.500.00 conversion fee <br />5. Pritnarycommoditie(s}lobemined:_ S~I•~j~ STb~,' <br />6. N I afownefr°[surfaceotaffectedlenda~ ~.~T'AT~. [UG ~C7LoQ-/t17D <br />7. Na i of owner of subsurface rigbu of affected land: '`fie e1F (iJ>;{o(.ES /~ ~~ ~-OQ~ <br />If 2 or more owners, refer to Exhibit O. <br />S. Typle of mining operation: ~ Surface Underground In-situ <br />9, Location Infortttation: the center of the azea where the tnajodty of mining will occur lies in: <br />AI. MERIDIAN (check one): <br />V (write number): <br />fill' (write nrunber and check t[uection}•~ <br />(write number and check direction): <br />iR SECTION (checL one): <br />iR/QLJARTER SECTION (check one): <br />tL DESCRIPTION (miles and direction <br />COUNTY: U~RwtEi~ <br />/ 6th (Colorado) _ 10th (New Mexico) ___,_ Ute <br />S ~Io <br />T ~ _/North _ __ South <br />R o _ East _ West <br />_NE _NW _ILSE _SW <br />_NE _NVJ _~SE I/ SW <br />from neazest town and approximate elevation): ~4. S M t L <br />Ln21K)O k~CAZrox.M.tTF F~(.-.!/VRTtOrJ '~ <br />SC~. <br />