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JUL 2 6 2004 <br />of Minerals end GeoloBY <br />United States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction, subject to a <br />fine of up to 510,000 and imprisonment up to 5 years. <br />NOTICE <br />The Paperwork Reduction Act of 1995 (44 U.S.C. 3501 <br />e[ seq.) requires us to inform you that: <br />BLM is collecting this information to process your <br />application and effect a binding contract. <br />BLM will use this information to identify and <br />communicate with applicants. <br />You must respond to this request to get a benefit. <br />A federal agency may not conduct or sponsor, and <br />you are not required to respond to, an information <br />collection which does not have a currently valid <br />OMB control number. <br />AUTHORITY: 30 U.S.C. 601 et seq,; 43 CFR 3600 <br />PRINCIPAL PURPOSE: BLM uses this information to <br />identify the parties entering into contracts for disposing of <br />mineral materials. <br />ROUTINE USES: BLM will transfer information from the <br />record or the record itself to appropriate federal, state, local, <br />or foreign agencies, when relevant to criminal, civil, or <br />regulatory investigations or prosecutions. <br />EFFECT OF NOT PROVIDING INFORMATION: If you <br />do not provide this information to BLM, we will not be able <br />to process your application for a contract. <br />BLM estima[es the public reporting burden for this form at <br />an average of 30 minutes per response, including the time for <br />reviewing instructions, gathering and maintaining data, and <br />completing and reviewing the form. Direct corrtments <br />regarding the burden estimate or any other aspect of this <br />form [o U.S. Department of the Interior, Bureau of Land <br />Management, Bureau Clearance Officer, (1004-0103), <br />1849 C St., NW., Mail Stop 401 LS, Washington, D.C. <br />20240. <br />1. Conditions of approval attached to Categorical Exclusion Record, CO-SJFO-02-034, must be adhered to. <br />2. First and last installments are due prior to any surface disturbing activity. <br />3. Mine Land Reclamation Permit must be approved and a copy provided to the Bureau of Land Management prior to <br />any surface disturbing activity. <br />4. Reclamation Bond must be filed with the Division of Mines and Geology, or Bureau o(Land Management prior to <br />any surface disturbing activity. <br />