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<br /> ~`- <br />-fe.m x9xo-t iss <br />vnrsED srA <br />(November 19]]) DEpARTYENT OP THE lNTER[OR <br />BUREAU OF LAND NANAGENENT <br />Title i, Sec. 29(e) of the Nlrtenl <br />M;Sece.302(b)eM SOKe)o! P.L. <br />tar -cr}~a <br />u/ay%dW Y <br />FORM APPROVED <br />OMD NO. 02-R0996 <br />SerLl Number <br />B8e0ena- C 6-P-S`1-6 <br />T32, 1]60. <br />INSTRUCTIONS ON REVERSE <br />-~z tiY - aD:]o - ~ .. <br />Occidental Oil Shale, Ina. tGrand Junction, CO '815.02 <br />2. Give legal description of pablie lands (a which you ere applying <br />TOWNSHIP RANGE SECTION SUBDNISION <br />75. 9JN 29 - SN; <br />(SEE ATTACHED NAPS) <br />Nerlabn Sleta Couvly Aeres (nembeq <br />-t Colorado Garfield 5 <br />3. Proposed date(s) of sae: From March 1, 1984 to March 21. 1964 <br />4e Are you 21 years of age or over? b Are you a citizen of the United States oc lleve youdeclara <br />'(~ Yes [] No' your iutmtian? LJC) Yes [] No <br />As applicant, ere yon a Q Pertmrship [] Association ®Corpocatioa; Q Individual(s); <br />c. a en agellry aE [] Federel Govercment Q State Government Q Political subdivisim aE any state? <br />d. Are the statements required by Instruction Number 2 attached? Q Vas ~ No Q Not applicable <br />5. Arc you mekiag tbis epplicetim fm your own use and benefit? ®Ym Q No (1l "no," explain) <br />6. Are the lands now improved, occupied, or nrnsi? ^ Yes [g] No (}('yes," describe iwprovemrnts and par <br />poses, idertti/y users and occrrpartts) <br />7a. What doyen propose to use the lands Ew? <br />Perform soil tests necessary for engineering design in preparation to application <br />for right-of-way permit <br />b, Whet improvements, including sanitation Eacilitim, do you intend to meke7 (Describe impmvemmts and attoeb <br />droudngs, i/ mnvmirnd <br />For this application -none. <br />Eventually, apply for right-of-way to construct 5 acres <br />(more or less) of evaporation ponds <br />Whet Is the estimated I d. What to the proposed scarce a[ water Eor domestic or other uses? <br />a Gnat of proposed improve- Not applicable <br />ment? S Q <br />~., Heve you enclosed (cling tee o[ S10? Q Yes '[,{f No (See (nstmcrion Number 31 <br />} CRRT(FY 771st the lnformatfon glum by me 1n this application !e floe, rnmplete, aDd cortect fo the beat of my <br />knowledge arld belief end Is given in good Ee[th. <br />2-21 -$ <br />(Dale) <br />Title IB U.S.C. Section 1001, makes Ir a crime (w any pernov knowlagly and wliaully to maY.e to any aepertment or <br />