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6. 7. - 2 - Name of owner ofthe subsurface riehts ofaRected land: QOM Name o[owner of the surface of affected land: ToM M ~• M~ KLNNA / E LORI L ~ O.v02S L Ker./NR~ / Eclo,J L:o uOriS 7.1 Names of the holders of any recorded easements on the affected land: ,s/o,vE /CuowA! 8. Tvoe of mining ooeration: C Surface Undergro und In-sim 9. Location information: The center of the area where the majority of m ining will occur: l COUNTY: N U G/'rt dt /l O PRINCIPAL MERIDIAN (check one): ~ 6th (Colorado) 10th (New Mexico) Ute SECTION (write number): S ~_ TOWNSHIP (write number and check dveaion): T 2L _ North t South RANGE (write number and check dveaion): R fo4 _ East ~_ West QUARTER SECTION (check one): _ 1JE X NW _ SE ~ SW AN» F1E SE t QUARTER/QUARTER SECTION (check one): _ NE , NW ~_ SE SW GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximau elevation): /0ni,lLS EA51of C/q/SeNbvi9 ~ANgL(ANp A~ E/evA~{,'o~/ (~~p Ft 10. Primary future (Post-mioinel Isnd use (check noel: Cropland(CR) _ Pastureland(PL) _ General Agricuhure(GA) Rangeland(RL) _ Forestry(FR) _ Wildlife Habitat(WL) _ Resideotial(RS) _ Recrearion(RC) _ IndustriaVCommercial(IC) _ Developed Water Resources(WR) _ Solid Waste Disposal(WD) 11. Primarvpresent land use (check noel: _ Cropland(CR) _ Pastureland(PL) _ General Agriculture(GA) Rangeland(RL) _ Forestry(FR) _ Wildlife Habitat(WL) Residential(RS) _ Recreation(RC) _ IndustriaUCommercial(IC) _ Developed Water Resources (WR) _ Mining (MN) 12. If this operation will use designated chemicals, or will result, or presently has acid mine drainage -you cannot use this application form. You must submit either a ] ] Od or 1 ] 2d application form for Designated Mining Operations. In either case, you must list any acidic or toxic-forming materials, exposed or disturbed as a result of the mining operation, and whether the operation will result in or presently has acid mine drainage: 13. Descriotion of Amendment or Conversion: If you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s): N~,~