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LIMZTSD IMPACT OPERATION (110) <br />F III IIIIIIIII IIII III ~F_((~_ F9_(V F(1)n,`` <br />CHECK ONB: i New Application (Ru~_ _. _, 999 inversion A~urcat~oloJRtule 1.11) <br />Permit # M (provide for conversions of existing ermits) <br />~~~~~~(;vlinerals & Geoi~9Y <br />The application fora Limited Impact Designated Mining Operati amation Permit contains <br />three major parts: (1) the application form; (2) 8xhibite A-J, any required sections of <br />Exhibit S and Geotechnical Stability Exhibit, as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; an (3) the application fee. When you submit your <br />application, be sure to include one (1) sinned and notarized original and one (1) copy of the <br />application form, two (2) copies of 8xhibite A-J, appropriate sections of 6.4.19 8xhibit S <br />and 6.5 (Geotechnical Stability 8xhibit), as required, and a check for the application fee <br />described under 14) below. Hxhibite should not be booed or in a 3-ring binder; maps should <br />be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the <br />information in the format and order described in Chie form. <br />zszzzzaaazzzazszvzzzcasazszzzzzzzzaiviizzzaizzzezszzzixzsviisvaivaaiizasaazzzaasvzzzzzizza <br />GBNSRAL OPHRATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />aaaiiiCYOxLaaCaiiiaaaCOxaCiliizaaiiiiiiiiiiSiiitii i f tit i i i aiiiiiifiiiaai6aaa <br />1. Applicant/operator or company name (name to be used on permit): <br />1.1 1~pe of organization (corporation, partnership, etc.): L~OAL~iR d7i~~/ <br />1.2 I.R.S. Tax ID No. or Social Security Numberl:I AL-/a.~ ~~'~ <br />2. Operation name (pit, mine or site name): (,OLA I:iL1 MILL <br />3. Permitted acreage (new or existing site): permitted acres <br />3.1 Change in acreage (+ or -) acres <br />4. Pees: <br />4.1 New Application ~ 5875.00 application fee <br />4.2 Conversion Pee (from 110d to 110 87 00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: G oL0 s/LyEJL <br />6. Name of owner to the subsurface rights of affected lend: ~~ C. <br />7. Name of owner to the surface of affected land: L). 0, ~ Sn/C. <br />8. Type of mining operation: _ Surface _ IIndarground /In-situ ~{{,{,/N~ <br />9. Location information. The center of the area where the majority of mining will <br />occur lies in: <br />coIINTx: BouLde~ <br />PRINCIPAL MBRIDIAN (check one): / 6th (Colorado) _ 10th (New Mexico) _ IIte <br />SBCTION (write number): S 1~ <br />TOWNSHIP (write number and check direction): T _L i/ North _ South <br />RANGE (write number and check direction): R /~L _ Saet ~q West <br />QIIARTHR SECTION (check one): / NH _ NW _ SS _ SW <br />Q021RTSR/QOARTBR SBCTION (check one): J[ NH _ NW _ SS _ SW <br />GBNSRAL DBSCRZPTION: (miles and direction from nearest town sad approximate <br />elevation) ~ 14'a F6ET- ~O f~~y[_F,Q~f Beuln~~ <br />10 <br />Correeoondence Information: <br />APPLICANT/oPBRATOR (name, address, and phone of name to be used on permit) <br />Contact's Name: J wAY,VETAnvaJ CeEN.HGO•~GuIE,(/ ~~QCEO Tit1e:~,R.G.fIAG T <br />Company Name: <br />Street: <br />City: <br />state: <br />Area Code: <br />K 99-74~IG <br />Telephone: <br />co ~~-~O9-~o~ w~ ~ zip toes: ~d112L <br />