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r • Illiiiliililillllll • R~~E~~!E®~ 9~~ 999 ~ JUL G 1987 RECLAMAT ONJIVISiON LIMITED IMPACT OPERATION (110) APPLICATION FORM This form contains two ma,~or parts: (1) General Operation Information and (2) Exhibits A-G. When you submit your application, be sure to Include two _s_i~ne~d copies of the General Operation Information, two copies of Exhibits A-G, and a c e k for the application fee described under (4) below. To expedite processing, please provide the Information in the format and order-described in this form. ~n.~ ~_~I saasaaaassa:aaaaaa^azaaaaauaasauaaaaaaaaaaaaaaazaaaaaaa:a a-: z a a aaaaaaauaaaas+ GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below, asaaaaaasaaaaaasaaaaaaasoaaaaaaaaazaaaasaasa^aa:azaaaauaaassaaaaaaaaaaaaaaaaaazasaausa 1. Applicant/Operator Name: COi.ORAhO Of1ARRT F.S. 7NC_ 2. Operation Name (Pit, mine or siteiname): SISKIN 3. Application type: Limited Impact Operation (110), 4, Application Fee for Permitted Acreage* 9 permitted acres. (S10 x (affected ecres) + 525,00).* Note permitted acreage and application fee and attach a check for this amount when you file. iis.oo application fee. 5. Substance(s) to be mined (e. g., gold/silver/gravel): t1F.CORATIV F. cTONF. 6. Owners(s) of Substance to be Mined (check applicable box(s)): ® Private O State O Federal O Indian 7. Owner(s) of Record of Affected Land (check applicable box(s)): Lr- Private ^ State ^ Federal ^ Indian 8. Type of Mining Operation (check applicable box(s)): DD Surface ^ Underground ^ In-situ 9. Location Information. The center of the area where the majority of mining will occur ties in: COUNTY: CUSTER PRINCIPLE c ec one ^ 6th (Colorado) D 10th (New Mexi co)D Ute TOWNSHIP (write number and check direction): T~J~ ^ North ® South RANGE (write number and check direction): _ R ~_ ^ East ® West SECTION (write number): S 76 QUARTER SECTION (check one): ~ -- ® NE ^ NW ^ SE ^ SW QUARTERlQUARTER SECTION (check one): ® NE O NW ^ SE O SW GENERAL DESCRIPTION: (miles and direction 3 MILES SOUTHE AST SILVE RCLIFFE, CO from nearest town and approximate elevation) eL. s3oo * If the operator is a unit of State or county government, an application fee is not required. A fraction of an acre must be counted as one acre for fee calculation.