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ooG ~~i STATE OF COLORADO
<br />DMSION OF MINERALS AND GtOLOGV
<br />Departmrn; ul Natural Rcwurre+ n
<br />,) t) SheNrtun St., Room i I ~ -~C J /rl ~N 7' ~ C U L O RA D O
<br />Denver. Colorado 80i0I ~ EC A71AC ~/ tt t v I s t o N u r
<br />mtonc~. no» abe-3sai M I N ~R A L 5
<br />fAx 1)o)t e)iato6 G E O L O G Y
<br />RECEIVED LIMIIEU IMPACT OPF.RAT70N (110(2)) of ClwNw,lON•N,NING
<br />f wllrr.fl ~t N(3
<br />RF.CI,AMATIUN PERMIT -
<br />MAR 2 8 °C`1F 1- , Bal lTwmf
<br />APPLICATION FORM RECE,V -- -' x;[„tNN„
<br />6~cC,nn. •~ M11p ri~.~... _'.IrLlgl'i p ) (' C RwdlGtotRe
<br />A f ('1 0 I L~J ~.. fmWx~lxrrltn
<br />M f~ Rwuld W CMY
<br />CllEC1CDNE _~_NewApplicalion(Rulc1.4) ~Cunvetraonjpphcauoa~Ru{eSysl~~Gfrol,arrav„p,,;>,,,,n„,
<br />Natural treNUne irN.re
<br />PemtittYM•_- _ (Provide(areanverxionsofexixtingpemtitx)
<br />the appbati,xf (ar a Caroled lutpact I)<sigttnted Muting Operntitm Reclatrntiun Penttit contairo (lace rln)or pans: (!) ilrc application
<br />form; 12) Exhibits A-J, airy teyuired uctinnx of Exhibit S and CcvNC>;futical Stability I?xhihit, m Rquirtd by tM O1Ftcc, atut outlined m
<br />Rules 6.1, 6.2, h.3, 6.4.19 arui h.5; and (3) Uac appliwixm fee. When you suttrmt your appliawnrnt, be sure to tnt:ltltk one (I l sigctnl aad
<br />1laterilCal arigtrul att<1 one (1) copy of the appliuttan furtrt, two (2) copies of [ixlobits A 1, appropnnte atctiaas of 6.4.19 ExhlbO S ual h.5
<br />(CrIXlrccttmral Stability Exhibit), as [rquitcd, atld a check fa the application fee Iksenbed tinder (4) below. Cxhibi[s atwuld Iml be benuld
<br />ur in a 3-rtn8 biruler; reaps shwld be folder to 8 IR" X I I" of 8 1.2' X 14" sire. "Io enpetLrc pmcessmg, pkace provtdc the tntornation
<br />in the fonrmt arxf tnJn tkscnbod in this form.
<br />GENERALOPl:RATION INFORMATION
<br />'type trc print dearly, in the apace provided. dl Information deacrlbed Ibcbw y!5~
<br />1, ~Ptlrynx/ ~ew~raler nr tr ~ nor nv~tnnme to he aavA en Ilte en rre~!,: ~ ~F P,, Lam' ^t~ ./,17 Se =n~'
<br />LI lYpcofotgnninlionlcor)wraholt,pannetxhip,etc.): _. -LQl-~trr~LlJ~ - - -
<br />L2 I.R.S. Tax ID No.: ~ ', - ~'(c C' C.~ C+ ~ ~ T
<br />2, I]rferatloa raa~tlGjj111 mine ar alle nv meL• ~ ~ C ~ I Rc, ,~___l+- _7 /~ -
<br />3, P mill If fn er raivlinv tel: -^SL--pcrtniped aCiea
<br />4. Ytaa:
<br />4.1 Ncw Apphcahon r Sx7s m application fee
<br />4.2 ('nnverston Fee Iftnm 1164 to 110(2). (Rule 1.1 L2Q)) eA75 txt converswo fee
<br />S. Pri n cmm~nrlltlNal to be naineA: ( ~~'nI 1~) ` (' ,,C ~_ ~,. } - /'~,,-,/
<br />6, Name of owner In the .ur(a._w of ^f(ertM lend: ! ~;~j~ [~J nQ I I-~r~~J~! C111.Y )
<br />~, Na of owner In the soh nrtaM rl~a of aReelM Iona! 1 ~~:1 ~ff'f Ia I ~~`e ~ n-+~~ L~~Z[=~Gt
<br />$, 'T~tae nl miei ~ancrn N+rn• -i Surtice - Lladergrtwnd In-anU 1
<br />f'E nl PZT
<br />ally w oroce a,
<br />Mined (and RlN IYnaunn Kdvt ~nrl Iny~rlN Mine
<br />Ctalundo
<br />farolugical $urvry
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