REV88413

• Permit No: M1994118
• IBM Index Class Name: Revision
• Doc Date: 10/16/2003
• Doc Name: Application
• From: Fremont County
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

6.
7.
8.
9.
Name of owner of the subsurface riehta of affected la
Name of owner of the surface of affected lead:
7.1 Names of the holders of any recorded easements on the affected land:
Tvoe of mining oceration: f Surface Underground
Location information: The center of the area where the majority of mining will occur:
COUNTY: ~>~(Z
In-situ
PRINCIPAL MERIDIAN (check one): / 6th (Colorado)
SECTION (write number): S Ile
TOWNSHIP (write number and check direction): T ~~
RANGE (write n~ber and check direction): R ~f °~
10th (New Mexico) Ute
North ~_ South
East ~ West
QUARTER SECTION (check one): NE NW / SE SW
QUARTER/QUARTER SECTION (check one): NE / NW SE SW
GENERAUDESCRIPfION: (the ntmiber of [Hiles and direction fiom dte nearest town and the approximate elevation):
(o Mtt_~ iii: otF vac-rot t ~O~ R1.Da
10. Prmsarv future (Foal-mmroe}land use (check one
_ Cropland(CR) _ Pasturelsnd(PL)
/ Rangekwd(RL) _ Fotestry(FR)
Residential(RS) _ Recreafion(RC)
_ DevelopedWa[erResotrrces(WR)
11. Primary oresent hwd_pae (check one
Crophutd(CR) _ Pasturel~d(PL)
JL Rangehmd(RL) _ Forestry(FR)
_ Residential(RS) _ Recreation(RC)
Developed Water Resources (WR)
_ General Agriculttne(GA)
Wildlife Habitat(WL)
_ hufirshiaUCommereial(IC)
_ Solid WasteDisposal(WD)
J General Agricultnre(GA)
_ WildlifeHabitat(WL)
_ IndustriaUCommereiai(IC)
_ Mining (!\'II`l)
12. If this operation will nse designated chemicals, or wdl result, or presently has acid mine drainage -You cannot use this application form.
You must submit either a 1 lOd or 112d application fo[m for Designated Mining Operations. In either case, yon must list a~ acidic or
toxic-forming materials, exposed or disturbed as a result of the mining operation, and whether the operation will tesnh in or presently
has acid mine drainage:
13. Deacriotion of Amendment or Conversion:
If you are ameadm(g~or converting an existing operation, provide a brief narrative describing the proposed change(s):{
~~u~lra. cal.- Yx.r.7~rt3-/-Nc^ Giv~N~r, \\N TcC-v,\- BtLY~zRI D\ST U\~\~3) (~1~
Q~Pos\t,o-N\>J/ of (NoP1~D`ST~RI'~F'~{ ~F~~T~D ~rNp ~uNDaRtEs `i-o
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