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~.'_• ' ~ • •_ RECEIVES-~ :, ' FEB 101987 MINED LAND LIMITED IMPACT OPERATION (110) IIECLAMATION DIVISION APPLICATION FORM This form contains .two ma,)or parts: (1) General Operation Information and (2) Exhibits A-G. When you submit your application, be sure to include two sk~i n__e~d copies of the General Operation Information, two copies of Exhibits A-G, and aleck for the application fee described under (4) below. 7o expedite processing, please provide the information in the format and order described in this form. ~y~ _ ~ ~ .~~ q avavaavaaaaaaavaavv=aavavavvaaaaaaaaaaaaaaaaavaaaaaaaaavnaaaa aaaaaaaaaava vaaaaaaaaaav GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. avavavavnaaaaaaaaaaaaaaaavaaaaaaaaaaaaaeaaaaaaaaaaavaaavaaaaaaaaaaaaaaaaaeaeaaaavsaaeaaaa 1. Applicant/Operator Name: Rio Grande County 2. Operation Name (Pit, mine or site name): so~ch Fork Pit 3. Application type: Limited Impact Operation (110). 4. Application Fee (E10. x (affected acres) + E25.00).* N/A affected acres. ti Note affected acreage and application fee and attach a check for this amount when you file. N/n application fee. 5. Substance(s) to be mined (e. g., gold/silver/gravel): sand/Gravel 6. Owners(s) of Substance to be Mined (check applicable box(s)): ^ Private p State ^ Federal a Indian 7. Owner(s) of Record of Affected Land (check applicable box(s)): ^ Private ~ State ^ Federal ^ Indian 8. Type of Mining Operation (check applicable box(s)): Q Surface ^ Underground ^ In-situ 9. Location Information. The center of the area where t he ma,)ority of mining will occur lies 1n: COUNTY: Rio Grande PRINCIPLE c ec one 6th (Colorado) xxl0th (New Mexico) Ute TOWNSHIP (write number and check direction): T 40 1D North ^ South RANGE (write number and check direction): R q (x East ^ Nest SECTION (write number): S QUARTER SECTION (check one): ^~ E7 NW ^ SE ^ SW QUARTER/QUARTER SECTION (check one): ^ NE ^ NW ~I SE ~ SW GENERAL DESCRIPTION: (miles and direction 10 miles west of Del Norte on Hwy. 160. from nearest town and approximate elevation) * If the operator 1s a unit of State or county government, an application fee is not required. A fraction of an acre must be counted as one acre for fee calculation.