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8. <br />9. <br />10 <br />11 <br />12. <br />13. <br />-3- <br />Name of owner of the subsurface rights of affected land: t3 rl~ Oof/'t Sr o1 //oa~~j~ioanfS~f~Cjd ~C~GroldPA.Co, JJOr/O/'~33 <br />Name of owner of the surface of affected land: ~i 1l ~u/'/`!~ :21b77/lbvets ~,2/~Or, ~jdPr~ Cc~ `/4'/oJ - gy33 <br />LOCATION INFORMATION: The center of the area where [he majority of mining will occur: <br />COUNTY: la P/erg <br />PRINCIPAL MERIDIAN (check one): ~ 6th (Colorado) _ 10th (New Mexico) _ Ute <br />SECTION (write number): S ~_ <br />TOWNSHIP (write number and check duection): T ~(~ ~ Nozth _ Soutlt <br />RANGE (write number and check direction): R ___/_L_ _ East ~ West <br />QUARTER SECTION (check one): _ NE ~ NW ^ SE _ S W <br />QUARTER/QUARTER SECTION (check one): _NE NW SE _SW <br />GENERAL DESCRIPTION: (the number of miles and direction from the neazest town and the approximate elevation) 12 3tP <br />i»,IeS~llv.~~,.rrtn~o eJPV2tion /d.6oo -iO,soo <br />Primary "future (Post-minin¢)" land use (check one): <br />_ Cropland(CR) <br />Rangeland(RL} <br />_ Residential(RS) <br />Developed Water Resources(WR) <br />Primary "present" land use (check onel: <br />Cropland(CR) <br />Rangeland(RL) <br />Residen6al(RS) <br />Developed Water Resources (WR) <br />_ Pastureland(PL) <br />Foresvy(FR) <br />_ Recreafion(RC) <br />Pastureland(PL) <br />Forestry(FT2) <br />Recreafion(RC) <br />_ General Agriculture(GA) <br />_ Wildlife Habitat(WL) <br />IndustriaVCommercial(IC) <br />_ Solid Waste Disposal(WD) <br />_ General Agriculture(GA) <br />Wildlife Habitat(WL) <br />_ IndustriaVCommercial(IC) <br />Mining (M!`I) <br />List any designated chemicals, acidic ortoxic-forming materials, exposed or disturbed as a result of the mining operation, and whether the <br />operation will result in or presently has acid mine drainage: <br />14. <br />15. <br />Description of Amendment or Conversion: If you aze amending or converting an existing operation, provide a brief narrative describing <br />the proposed change(s). _ _ ~ _ , _ _ - ~ _ „ ~ <br />Maps & Exhibits: Submit T'WO (21 complete. unbound copies of the following application exhibits: <br />RULES: <br />6.3.1 E}G-IIBII' A -Legal Description and Location Map .,^ {?l1C Din G, .vO eh4n9e <br />6.3.2 EXI-IIBTT B -Site Description an -~rl P 'OAtG, Nd C/L!n J °~ <br />6.3.3 E3C)-IIBTTC-Mining Plan o~ file O~'nG, wa c~~n1~ <br />6.3.4 EXIiIBIT D - Reclatnation Plan o n ~ile 4/hcS, NO ehAa'e <br />6.3.5 EXI-IIBfpE-Mapsdn ~;Je Dma, .+~o ~~An9e- a <br />6.3.6 EXIIIBIT F -List of Other Permits and Licenses Required o q Ti lP pM G~ n/0 ~1 ~A9 E <br />6.3.7 EXI-IIBIT G -Source of I-egal Right-to-Enter on ~/gyp q M 6, we e h gn ~ 2 <br />6.3.8 EXFIIBIT H -Municipalities Within aTwo-mile Radius a r ~i /P ,O1hG, ,/ve%a~9 e <br />6.3.9 EXIIIBIT I -Proof of Filing with County Clerkeq ~i l~ ~/q(¢, wo ejtAn9 e <br />6.3.10 EXIIIBIT J -Proof of Mailing Notices of Permit App00lication on {!t Ip OnIG, we ch9a+j e <br />6.3.12 EXHIDIT L -Permanent Man-Made Structures on tt l~ +Gm6 , w0 eh3n9 v <br />6.4.20 EXI-IIDIT T -Designated Mining Operafion Environmental Protecflon Plan o A •~i /e, w ~ ~~n"f P <br />6.5 GeotechnicalStabilityExhibit(asrequired)an~ilt?Ar)tre, tAloC{lgAg~ <br />8 Emergency Response Plano4•2~%P~/nG,+/oCAAn~je <br />1.6.2(1)(6) ADDENDUMI-Notice Requirements (sampleenclosed){/,iSe/aermPnt <br />--..,. , <br />