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. <br />•i <br />• • RE III IIIIIIIIII I 12) <br />.... r CRf'11 r <br />APPLICATION FORM <br />CHECK ONE: ~ New Application (Rule 2) _ <br />Conversion Application (Rule 1.10> <br />'~ ~ <br />~f <br />c,EP p g 1994 <br />~ Geo`,oaY <br />Amendment~;Ap'p~~ication (Rule 1.8) <br />,~.i u• . <br />The application for a Regular Operation Reclamation Permit contains three major parts: <br />(1) the application form; (2) Exhibits A-S; and, (3) the application fee. When you <br />submit your application, be sure to include one (1) signed original and four (4) signed <br />copies of the application form, five (5> copies of Exhibits A-S, and a check for the <br />application fee described under Section (14) on Page 3. To expedite processing, please <br />provide the 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: M~•``ab... ~ \~~'.z,,,~~.,,y~.\ ~ ~tsS...''~n-.nn.~5. L.~Q ,. <br />1.1 Type of organization (corporation, partnership, etc.): L~•..~.~X ~a..~-.avt~,~ <br />2. Operation name (pit, mine or site name): ~„r~,,.,., L „4n~c L~~~,~-~_~ P. ~- <br />` ~~ <br />2.1 I.R.S. Tax IO No. or Social Security No.: g~} -) 1 .;~ O ~ J~ <br />3. Permitted Acres: 1-1 C ~ Permitted acres <br /> Please indicate acrea ge to the nearest tenth (10th) acre. <br /> 3.1 Applica tion fee (see Section 14): ~1~~5 ~ Application fee <br />4. Substance(s) to be mined (e .g., gravel/gold/borrow) : o~~r~,,.,-e.~ <br /> <br />5. <br />Name of owner <br />of surface of <br />affected land: ~'-J //~ 'y- <br />~"L .\\..,_ /~qV-1 . `-,.~V~AL.. ~1"'L~. <br /> <br />6. Name of owner of subsurface rights of affected land : s~-.Q ~ ~ ~ L ~,~-~ <br /> If 2 or more owners. refer to Exhibit P. <br />7. Type of mining operation: Zc Surface _ Underground <br />S. Location Information: the center of the area where the majority of mining will <br />occur lies in: <br />COUNTY: M v-.ti-~vos sZ <br />PRINCIPAL MERIDIAN (check one>: ,Nt 6th (Color ado) ~ 10th (N ew Mexico> ~ Ute <br />TOWNSHIP (write number and check direction): T ~_ x North South <br />RANGE (write number and check direction): R ~_ _ East ~ West <br />SECTION (write number): S 13 <br />QUARTER SECTION (check one): NE ~ NW SE SW <br />QUARTER/QUARTER SECTION (check one>: _ NE _ NW ~ SE _ SW <br />GENERAL DESCRIPTION: <br />( <br />il <br />d di <br />ti <br />'-l <br />~ <br />!v <br />~ M <br />~ <br />= <br />m <br />es an <br />rec <br />on ~~w-•c, - ,.,:, <br />tz W o <br />~- <br />,,~z <br />. <br />~ <br />from nearest town and <br />approximate elevation) ~-e~o . C~ u-..~ e ~~~~--'~Tw. ~~~ s ~ SCJ ~'~ <br />pRICaINAI- <br />