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3- <br />7. <br />8. <br />9. <br />10. <br />Name of owner of the subsurface riehts of affected I <br />Name of owner of the surface of affected land: <br />Tyne of mining operation: ~_ Surface Underground _ <br />Location intormatioo: The center of the area where the majority of mining will occur: <br />COUNTY: <br />NE NW <br />PRINCIPAL MERIDIAN (check one): ~th (Colorado) l thh (New Mexico) Ute ~~ { <br />SECTION (write number): S ~~ <br />TOWNSHIP (write number and check direction): T 1~ North <br />RANGE (write number and check duection): R ~ East <br />QUARTER SECTION (check one): <br />QUARTER/QUARTER SECTION (check one): <br />GENERAL DESCRIPTION: (the number of miles <br />NE NW <br />In-sim <br />_ U ~~ <br />~:) South ~ ~ ~~ <br />~ Wen ~.~~~ <br />SE ~~W <br />SE SW <br />from the nea(est town and the approximate elevation): ~~ <br />1 I . Primary Mine Entrance Location (repoR in either Latimdell.ongitude or UTM): <br />Latitude/ionQitude <br />Latitude (I~: deg min sec OR Latitude (I~ ~ ~ .~~decimal places) <br />Longin:de (W): deg n.in sec Longin.de("~ //) '~ ~5 decimal places) <br />Universal Traoyerse Mercator (UTMI <br />UTM Datum (specify NAD27, NAD83 or WGS 84) Zone <br />Northing <br />Fasting <br />] 2. Primary future (Post-miniuaJ land use (check one <br />_ Cropland(CR) _ Pastureland(PL) _ General Agriculture(GA) <br />Rangeland(ftL) _ Forestry(FR) _ Wildlife Habitat(WL) <br />_ Residentia](RS) _ Recreation(RC) _ IndustriaVCommercial(IC) <br />_ Developed Water Resources(VJR) _ Solid Waste Disposal(WD) <br />13. Primary present land use (check one <br />_ Cropland(CR) _ Pastureland(PL} _ General Agriculture(GA) <br />Rangeland(RL) _ Forestry(FR) _ WildlifeHabitat(VJL) <br />Residential(RS) _ Reereation(RC} _ IndustriaUCommercial(IC) <br />_ Developed Water Resources (WR) _ Iviining (~} <br />l 4. if this operation will use designated chemicals, or will result, or presently has acid mine drainage - you c to 1 Ot use this application form. <br />You must submit either a 110d or 112d application form for Designated Mining Operations. In either case, you must list any acidic or <br />toxic-forming materials, exposed nr disturbed as a result of the mining operation, and whether the operation will result in orpresendy has <br />acid mine drainage: <br />/hire ~i~i/~ .h~~ ~>, CTei;~'e nr ~y`~. ~ ~rrrn;no /1/.r~rrii~/c -~ised <br />l~ <br />in, y"Ir;s <br />I <br />b o~,~oer~a f; o rr, I~F' ~Lny mu f~~/u(s a6~~ ``Z1nc~oVered -rn~.y <br />d <br />~ <br />' <br />,,~) t <br />t <br />e hst.nd /ed ~s ~s~.r; ,bNd ~ ~r <br />t <br />~f ~ ~n~ ~ ir?y ~Ia n , <br />