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~~ --~-~ III IIIIIIIIIIIIIIII ~ <br />MINED LAND RECLAMATION <br />Application Worksheet/Checklist <br />Regular 112 Application Name Colorado Li rile NoM_85_038 <br />Complete (Filed Uate <br />ITEM <br />COMPLETE ADEQUATE COMMENTS <br />Application form: <br /> <br />1. Name of Operation <br />tiC-'Z.h~ NCI <br /> <br />Hf'PL ~ c.a•rw~ <br />2. Name of Applicant/Operator <br />3. Address & Phone (Local) <br />4. Address & Phone (General) <br />5. Person to Contact <br />6. Parent Corporation, if any <br />1. Surface Owners <br />ti. Mineral Owners <br />y. Source of Legal Right-To-Enter <br />10. Type of Mine/Substance <br />11. General Location & Elevation <br />12. County <br />13. Acreage <br />14. fee <br />15. Present Land Use <br />16. Surrounding Land Uses I <br />17. Proposed Future Use <br />~2,v~ <br />