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V <br />1 <br />• <br />DIVISICiJ OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS <br />Regular (112) Mining Operation <br />Application Worksheet/Checklist <br />' New App: }~ Amendment App: Conversion App: ~X <br />Operator: d/IJQ~iI~ ~,(/~~1~~ Mine ID: i~,L~7 <br />Mine Name: U~2P(.1P1'1 !"~ f ~~n Submittal Date: ~~~ 1 <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />ITEMS <br />COMPLETED 1 2 3 4 5 6 <br /> V / / ~ <br />ITEMS <br />COMPLETED 7 8 9 10 11 12 <br /> ~ / ~ / V <br />ITEMS CONV/AMEND PERMITEE SIG <br />COMPLETED DESCP RESP <br /> li/2/3/ nofWc~ <br /> / <br />V 4 /5/g/ <br /> 7/ Ea/9/ <br />• III III III IIIIIII III <br />999 <br />MAPS and EXHIBITS (Rule 6.2) <br />ADEQUACY COMMENTS <br />EXHIBIT A - 6.4.1 - LEGAL DESCRrpTION:/ <br />