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N~ '' • IIIIIIIIIIIIIIIIIII ~ ~ RE , DIVED „ ~~+N D~p SAN 3 1 1~3Q REGULAR (112) PERMIT MINED LAND APPLICATION FORM REC_AMATION DIVI4':>`: This form contains two major parts: (1) General Operation Information and (2) Exhibits A-P. When you submit your application, be sure to include four signed copies of the General Operation Information, four copies of Exhibits A-P, and a c e k for the application fee described under (4) below: To expedite processing, please provide the information in the format and order described in this form. ==Y=y~===--- _ la/9-~--- ------------------ ---- --- - - --- -=--------- GENERAL OPERATION INFORMATION ~ iy53 .8`iooa c~ Type or print clearly, in the space provided, all information described below. 1. Applicant/Operator Name: tea(-,~,G.E -C Y PS U M ~ ~O DVGrS 2. Operation Name (Pit; mine or site name): ESC-,LE CiY1OSVi'VI M INL:+ 3. Application type: Regular (112) Permit Operation. 4. Application Fee for Permitted Acreage* lf09~lo(a permitted z ~, Sv acres. ,~ fln~uo+ (5599 + ya-5:-99/acre; 1st. 50 cues; ~ q ~ ( D y~ 5~E1$:09/acre, 2nd. 50 acres; lcre, 3rd. 50 acres; o•r~$a:-60/acre; arty additional acreage; maximum fee of 52,000.00).* Note permitted acreage and application fee and o„ attach a check for this amount when you file. ~ D D D application fee. 5. Substance(s) to be mined (e. g:; gold/silver/gravel): l ~p~ u rr/ 6. Owners(s) of Substance to be Mined (check applicable box(s)): ~ Private _ State _ Federal _ Indian 7. Owner(s) of Record of Affected Land (check applicable box(s)): _ Private _ State ~ Federal Indian 8. Type of Mining Operation (check applicable box(s)): ~( Surface _ Underground _ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: E/~C, Lir PRINCIPLE c ec one ~ p(6th. (Colorado) 10th (New Mexico) Ute TOWNSHIP (write number and check direction): T ~_ North ~ South RANGE (write number and check direction): R ~ _ East ~ West SECTION (write number): S 2 QUARTER SECTION (check one): ~(~ NW SE SW QUARTER/QUARTER SECTION (check one): _ NE = NW ~ SE = SW GENERAL DESCRIPTION: (miles and direction / j11 i !-~ N-G-. of 'Ivwn o~ ~c~p3vvvi from nearest town and approximate elevation) lO 9 S~ * If the operator is a unit of State or county government, an application fee is not required, A fraction of an acre must be counted as one acre for fee calculation.