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~ ~ <br />' Appendix A. <br />APPLICANT'S QUESTIONNAIRE TO THE COLORADO DIVISION OF WILDLIFE <br />for Limited Impact Operations <br />' (Permit 110-1 and 110-2) or <br />Regular Operations Permit 112) <br />Instructions to the applicant: Complete both sides of this form. Send the <br />' comp e e orm o e appropria e Division of Wildlife (OOW) Regional Manager. <br />Regional Managers: <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 <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 the format and order <br />described in this form. Type or print clearly. Incomplete questionnaires will be <br />returned. Please allow 30 days for processing of completed form. Your cooperation <br />is appreciated. <br />' PLEASE ATTACH THE FOLLOWING INFORMATION TO THIS FORM: <br />A. Minin and Reclamation Plan: Description of proposed reclamation plan or <br />su it 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 />P a Suggested maps are those prepared for the MLRD application. <br />' For the 110-1 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 132 Permit, Regular Operation: Exhibit C - Pre-Mining and Mining Plan <br />Map(s) of Affected Lands, and Exhibit F -Reclamation Plan Map. <br />1. Operation name (plt, mine): River Road Gravel Pit Extension <br />' 2. Application type (check one): Two Acre Limited Impact Operation (110-1) <br />Limited Impact Operation (110-2) <br />AMENDMENT TO x Regular Permit Operation (112) <br />3. Name Of appllcant/Operator: United Companies of Mesa County, Inc. <br />AddTBSS: p, p. Box 3609 Grand Juntion, CO 81502 <br />Phone Number: (303) 243-4900 <br />' 4. Name of contact person (if different from above): Paul E. McGehee <br />Address: p. 0. Box 3609 Grand Junction, CO 81502 <br />' Phone Number: (303) 243-4900 <br />5. LOCat].On Of mine: Mesa County: NWZ, SW~, Sec 6 T1S, R1W, Ute Meridian <br />(County, Township, Range, Section to nearest quarter quarter <br />(OVER) <br />-10- <br />,I <br />