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- ---------- °' REGULAR OPERATION (112) OCT 2 7 1995 . RECLAMATION PERMIT ` APPLICATION FORM -. CHECK ONE: Nev O,,f�t,A,110ppM� e'0'0 o Application (Rule 1.4.5) AIDendmr�L+) � t1oII (Rul 1 ) Conversion Application (Rule 1-11) Permit No. M- -7-7 - 007 t4f, (provide for amendments and conversions of existing permits) The application for a Regular Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A-S and Geotee4mical Stability Exhibit; and, (3) the application fee. When you submit your application, be sure to include one (1) signed and notarized original and four (4) copies of the application form, five (5) copies of Exhibits A-R and any required sections of Exhibit S and the Geotechnical Stability Exhibit, and a check for the application fee described under Section (16) an Page 3. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/20 S 111 or 8 1/2• B 14, size. To expedite processing, please provide the information in the format and order described in this form. ek1°�3 GENERAL OPERATION INFORMATION Type or p in the space provided, all information described below. 1. Applicant/operator or company name (name to be used on permit) : Fie. ei Mn Ki (nC. d 'o C an 1.1 Type of organization (corporation, partnership, etc.) : 1.2 I.R.S. Tax ID No. or Social Security Number: 4(o -(0Z71�,E39 2. Operation. name (pit, mine or site name) : Ml)KIZOE GL4PiGUM QUAgVY 3. Permitted acreage (new or existing site) 10 permitted acres 3.1 Change in acreage (+ or -) +230 acres 3.2 Total acreage in Permit area Z40 acres 4. Fees: 4.1 Nev Application 91.875-99-- application fee 4.2 New Quarry Application —3n2Too quarry application 4.3 Milling Application (Non-DW) -- '�^ milling application 4.4 Amendment Fee -�— vo— aMA^dff^ent fee 4.5 Conversion to 112 operation (set by statute) 51.500.00 conversion fee S. Primary commodities) to be mined: G4 F<ROM 6. Name of owner of surface of affected land: MUnrcp2 (\oInc l 7. Name of owner of subsurface rights of affected land: MaUm (1Y � CAn � If 2 or more owners, refer to Exhibit O. a. Type of mining operation: �C Surface _ Underground _ In-situ 9. Location Information: the center of the area where the majority of. mining will occur lies in: Comm: PRINCIPAL MERIDIAN (check one) : 6th (Colorado) 10th (Nev Mexico) _ Ute SECTION (write number) : S T TOWNSHIP (write number and check direction) : T JV Lc North South RANGE (write number and check direction) : R ( q East K West QUARTER SECTION (check one) : NE K NW SE SW QUARTER/QUARTER SECTION (check one) : — NE — NW SE — SW GENERAL DESCRIPTION (miles and direction from nearest town and approximate elevation) : ASTwx r :(Ply �4 m>� m Ih cs� �4 (vlun(oe R3Y a SMLL& 0 a ca 5 75 ml6m Mril, do 1I'm nere or Smdoc Mrikkoe- ' zr B&6e.y u 1-. '� r, rox„✓�e GOOD -�OP� �vk AMSL I ORlCiNQL