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<br />-2- <br /> <br />3. Address and Phone Number of oZ ~ s %EG~..CtQrj~QL.l'1~/J CO. <br />Local Offices s3 ~- 4~~ ~3 <br />4. Address and Phone Number of <br />General Off ices ~'3 ~ _ t..~~ q 3 _ S3. y_ (~ 3 O (~ <br />5. Name and Phone Number of Person (j O f3 W E J~ ~ t <br />Staff Members Should Contact s 3 y . L,16 °I,j <br />6. Owner(s) of Record of Affected Land ljol,3 W E v / 6 E <br />(surface area) (If more than 2, list below) <br />C,u7tf a Q ~.v c` ~' t~i4+i7 G/¢•s7 r~ ~ (~ <br />7. Owner(s) of Substance to be Mined 1'JoC3 w~I~fCnE <br />(If more than 2, list below) <br />CA-Th~~ l~v <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 />~3F2 ~ <br />>QCtoi2DT-~ IIV ~QEiY/DrtJT- CDV~vT)/ <br />9. Type of Mine and Substance to be Mined ~Eti a iT <br />(Specify underground, open pit, 0 <br />quarry, etc. & substance(s) to <br />be mined) ~~Nm/V /T/= <br />10. General Location and Elevation J7 !7'1,CCS Eat aF <br />(Miles & direction from nearest <br />town & approximate site elevation) /¢r~7QC1~/ ~'CE~ar~onJ <br />h~ow.9.~e.1~ , CCS, <br />7.vo0 ter' <br />11. County <br />FQE mon~T <br />12. Acreage of Affected Lands F lvG ~~Q~ S /f/o l~ j"O E~/C;~ _(~ <br />(Total surface acreage to be ' <br />included in permit) /~E'lerY1~T' vh' C/~oNr <br />13. Application Fee (See applicable `/a, S 00 <br />Rule to determine amount) <br />