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<br /> <br /> <br />APPLICANT'S QUESTIONNAIRE <br />For Limited Impact Operations <br />(Permit 110-1 and 110-2) or <br />Regular Operations Permit 112) <br />~~~ I~~II~II~II~~I~~ • <br />,~ ,,,~ aea [VISION OF WILDLIFE <br />• ~ `- r, <br />,-•- <br />Instructions to the applicant: Complete both sides of this form. Send the <br />comp e e orm o e appropriate Division of Wildlife (DOW) Regiona~'~ Manager. <br />Regional Managers: ii Lec::.-;T'1i~l1~ <br />NW Region: 711 Independent Avenue Grand Junction, CO 81505 <br />NE Region: 317 W. Prospect Avenue Ft. Collins, CO 80526 <br />Central: 6060 Broadway Denver, CO 80216 r~4Jb O !1 I~~~ <br />SW Region: 2300 S. Townsend Avenue Montrose, CO 81401 <br />SE Region: 2126 N. Weber Colorado Springs, CO 80907 <br />To expedite processing, please provide the information in <br />described in iilis fdrn. Type or print clearly. :ncc~~.plete <br />returned. Please allow 30 days for processing of completed <br />is appreciated. <br />PLEASE ATTACH THE FOLLOWING INFORMATION TO THIS FORM: <br />^) <br />;~; <br />.s <br />Durango Field Office <br />the f ~~ton @hbineiptSey-Geology <br />^y UeSt.^.1^aircg !e'Ll ha <br />form. Your cooperation <br />A. Mining and Reclamation Plan: Description of proposed reclamation plan or <br />suTxnit Mining and Reclamation Plan as prepared for MLRD application. <br />B. Ma s- Submit copies of maps for the both the Mining Plan and the Reclamation <br />Plan. Suggested maps are those prepared for the MLRD application. <br />For the 110-'_ Permit, Two Acre Limited Impact Operation: Exhibit A - Location <br />Map Exhibit C - Affected Lands Map. <br />For the 110-2 Permit, Limited Impact Operation: Exhibit E - Mining Plan ,Map <br />and Reclamation Plan Map. ' <br />For the 112 Permit, Regular Operation: Exhibit C - Pre-Mining and Mining Plan <br />Map(s) of Affected Lands, and Exhibit F - Reclamation Plan Map. <br />- - - - - - - - - - - - - - - - - - - - - - - <br />1. Operation name (pit, mine): Blasting ~ P1ining. Inc. <br />2. Application type (check one): Two Acre Limited Impact Operation (110-1) <br />Limited Impact Operation (110-2) <br />~Reguia_ Per.~~it ~2rat?.... !L12;~ <br />3. Name of applicant/operator: <br />Address: 7452 CR 24B PO Bo <br />Phone Number: (970) 565-3388 <br />4. Name of contact person (if different from above): <br />Address: <br />Phone Number: <br />5. Location of mine: + <br />(County, Township, Range, Section to nearest quarter quarter <br />E~YZ, Nul ~ W z , NEiy, SEC. /3 j ; ) ,v 2 /s r,/ <br />(OVER) <br />-10- <br />.~ <br />