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0 <br />iii iiiiiiiiiiiu iii , <br />DIVISION OF MINEF.AL~ AND GEOLOGY <br />CONSTRUCTION MATERIALS <br />Regular (112) Mining Operation <br />Application Worksheet/Checklist <br />New App: Amendment App: ~ Conversion App: <br />Operator: ~)~k ~,(~-N~~ Mine ID: M ~~~~ <br />Mine Name: ~~Ka°,(~ ~, Ulan ~~-~- Submittal Date: ~/~'3 <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 7 8 9 10 11 12 <br />COMPLETED <br /> <br /> I/ N / ~/ '~ <br />ITEMS CONV/AMEND PERMITEE SIG <br />COMPLETED DESCP RESP <br /> ].~2/3/ <br /> / <br />/ 4/5~ 6~ „~ <br /> 7'~8'~9 v <br />MAPS and EXHIBITS (Rule 6.2) <br />ADEQUACY COMMENTS <br />EXHIBIT A - 6.4.1 - LEGAL DESCRIPTION:/ <br />