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<br />III IIIIIIIIIIIIIIII :,,D(2„ ~k'~E-_:1/, ,, <br />LIMITED <br />n[V~nnn ~1 MY rtliMl I JUL 2i 199 <br />APPLICATION FORM <br />r~, ,~ <br />CHECK ONE: New Application (Rule 3.2) Amend~~r~~'~14~p1'1•ca~tivgC;~,l~,le 1.8) <br />Conversion Application (Rule 1.10) <br />"~ <br />The application for a Limited Impact Operation Reclamation Permit contains three mayor <br />parts: (1) the application form; (2) Exhibits A-J; and, (3) the application fee. When <br />you submit your application, be sure to include one (1) signed original and one (1) copy <br />of the application form, two (2) copies of Exhibits A-J, and a check for the application <br />fee described under (3> below. To expedite processing, please provide the information <br />in the format and order described in this form. ~' <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />i. Applicant/operator name: <br />e_ <br />~ohp <br />1.1 Type of organization (corporation, partnership, etc.): (~orfJOr4~.~o.J <br />Z. Operation name (pit, mine or site name): ~P_r~~DU d ~~.(vlSet~ <br />2.1 I.R.S. Tax ID No. or Social Security No.: Si'~I- I f `7- 1'f q I ~'~ <br />3. Permitted acreage ~],R'~l 8 permitted acres <br />3.T Application Fee (New Application Only) $875.001I application fee <br />4. Substance(s) to be mined (e.g., gravel/gold/borrow): .Cn ~ d .C ~ 0 h C'. <br />5. Name of owner of surface of affected l and: /~e t ~ (_ ~ l~• ~ ~ 1 S Jl'1 Sn r air u P <br />6. Name of owner of subsurface rights of affected land: N.ei I ~. ~ .~r~ic /Vl. ~r,~hgG,, <br />7. Type of mining operation: ~ Surface _ Underground _ In-situ <br />8. Location information. The center of the area where the majority of mining will <br />occur lies in: I <br />COUNTY: 1.Q r i me r <br />PRINCIPAL MERIDIAN (check one): ~j 6th (Colorado) 10th (New Mexico) Ute <br />TOWNSHIP (write number and check direction): T ~_ y1 North South <br />RANGE (write number and check direction): R 2'~ _ East ~ West <br />SECTION (write number): S ~$ <br />QUARTER SECTION (check one): NE NW ~ SE SW <br />QUARTER/QUARTER SECTION (check one>: ~, NE NW <br />SE SW <br />GENERAL DESCRIPTION: _ <br />_ _ <br />(miles and direction <br />from nearest town and <br />approximate elevation) <br />~~i <br />