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<br />-2- <br />Address and Phone Number of <br />Local Offices <br />1140 Howard Street, Delta, Colorado 81416 (303) 874-3042 <br />4. Address and Phone Number of <br />General Offices <br />1140 Howard Street, Delta, Colorado 81416 (303) 874-3042 <br />5. Name and Phone Number <br />Staff Members Should <br />Inza Moc <br />of Person <br />Contact <br />(303) 874-4405 <br />6. Owner(s) of Record of Affected Land <br />(surface area) (If more than 2, list below) <br />Inza Mowbray as Devisee under the Last Wi11 and macramant of Tames y,~ Mowbrav. Deceased <br />7. Owner(s) of Substance to be Mined <br />41f more than 2, list below <br />nza Mowbray as Devisee er the Last Will and Testament of James W. Mowbray, Deceased <br />8. Source of Legal Right-To-Enter <br />(Indicate what type of proof is <br />included in EXHIBIT G - lease, <br />deed, notarized letter, etc.) <br />Entry will be made through appliant's premises <br />9. Type of Mine and Substance to be Mined <br />(Specify underground, open pit, <br />quarry, etc. & substance(s) to <br />be mined) <br />Open pit <br />10. General Location and Elevation <br />(Miles & direction from nearest <br />town & approximate site elevation) <br />3 miles more or less West of the City of Delta. Colorado nn n_S_ uwv- sn <br />z <br />11. lountylevation about 5200 feet <br />12. Acreage of Affected Lands <br />(Total surface acreage to be <br />included in permit) <br />9.75 acres more or lees <br />13. Application Fee (See applicable <br />Rule to determine amount) <br />