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~~ ~~'~ElVE® iiiiiirirrinirrrii LIMITED ......_.sss (1]0(2)) APPLICATION FORM MAR 7 1390 RAC'--: MAT ON p 0~ .~ ~~ The Application fora Limited Impact Operation Reclamation Permit contains three major parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the application fee. When you submit your Application, be sure to include two sig~ned copies of the Application Form, two copies of Exhibits A-F, and a check for the appTicel;ion fee described under (4) below, To expedite processing, please provide the information in the format and order described in this form. ~ . ~~ ~ 5 GENERAL OPERATION INFORMATION '"'~F' /~~X~ Type or print clearly, in the space provided, all information described below. 1. Applicant/Operator Name: Blasting !~ Minim, Inc. 2. Operation Name (Pit, mine or site name): Gardner Fit #2 3. Application type: Limited Impact Operation (110). 4. Application Fee for Permitted Acreage* 9,9 permitted acres. (E10 x (affected acres) + ~25.00).* Note permitted acreage and application fee and attach a check for this amount when you file.. $125.00 application fee. 5. Substance(s) to be mined (e.g., gold/silver/gravel): Gravel 6. Owners(s) of Substance to be Mined (check applicable box(s)): X Private _ State _ Federal _ Indian 7. Owner(s) of Record of Affected Land (check applicable box (s )): X Private _ State _ Federal _ Indian 8. Type of Mining Operation (check applicable box(s)): X Surface _ Underground _ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: Montezuma PRINCIPLE ER c ec one X 6th (Colorado) 10th (New Mexico) Ute TOWNSHIP (write number and check direction): T ~~ X North South RANGE (write number and check direction): R 14 East ~ West SECTION (write number): S ig. _ QUARTER SECTION (check one): XX~E- NW SE SW QUARTER/QUARTER SECTION (check one): _ NE _ NW g SE = SW GENERAL DESCRIPTION: (miles and direction Approx 2 miles SouthEast of Dolores. CO from nearest town and approximate elevation) Elevation: 760 0 * If the operator is 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.