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<br />This form contains two major parts: (1) General Operation Information and (2) Exhibits <br />A-G. When you submit your application, be sure to include two ~~s~~iggned~ copies of the <br />General Operation Information, two copies of Exhibits A-G, and a~ck for the <br />application fee described under (4) below. To expedite processing, please provide the <br />information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/Operator Name: <br />2. Operation Name (Pit, mine or site name): / TC.N~L L /"/ i <br />3. Application type: Limited Impact Operation (110). g q8'6 <br />4. Application Fee for Permitted Acreage* ' permitted acres. <br />(E10 x (affected acres) + 525.00).* <br />Note permitted acreage and application fee and <br />attach a check for this amount when you file. /~_s pZ'r application fee. <br />C <br />999 FEB 171987 <br />MINED LAND <br />RECLAMATION DIVISION ', <br />LIMITED IMPACT OPERATION (110) <br />APPLICATION FORM ~ - 87 - D o~ i <br />5. Substance(s) to be mined (e. g., gold/silver/gravel): ~'~ Ayc L <br />6. <br />Owners(s) of Substance to be Mined <br />(check applicable box(s)): <br />.Private ^ State ^ Federal ^ Indian <br />7. <br />8. <br />9. <br />Owner(s) of Record of Affected Land <br />(check applicable box(s)): <br />Type of Mining Operation <br />(check applicable box(s)): <br />,l~ Private ^ State ^ Federal ^ Indian <br />Surface ^ Underground ^ In-situ <br />Location Information. The center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: Qa(AMS' <br />~ <br />PRINCIPLE M RIDIAN check one~ <br />T,~ 5th (Colorado) ^ 10th (New Mexico)^ Ute <br />TOWNSHIP (write number and check directio n): T ~ ^ North ~ South <br />RANGE (write number and check direction): _ <br />R ^ East ,)s~, West <br />SECTION (write number): S <br />QUARTER SECTION (check one): ~ ^ NW ^ SE ^ SW <br />QUARTER/QUARTER SECTION (check one): ¢~ NE ^ NW ^ SE ^ SW <br />GENERAL DESCRIPTION• <br />(miles and direction ~ autE Esls- CF /JE~NA/F_'TT C'~~le'~~N So'crry <br />from nearest town and l' /~ <br />approximate elevation) CF ~`YjLH~-:~Y .36 intic ~Rof'a,27y- <br />* If the operator is a unit of State or county government, an application fee is not <br />required. A fraction of an acre must b'e counted as one acre for fee calculation. <br />