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m i ~ - 2 - '6. Name of owner of the subsurface riehts of affected land: 7. Name o[owner of the surface of affected land: <~rt~( 7.1 Names of the holders of any recorded easements on the affected land: 8. Tvoe of mininc operation: t~Surface Underground In-situ 9. Location information: The center of the area where the majority of mining will occur: COUNTY: /,p ~ r nx1 ~ PRINCIPAL MERIDIAN (check one): /6th (Colorado) 10th SECTION (write number): S 3 1 TOWNSHIP (write number and check dtrection): T ~_ ~ North RANGE (write number and check direction): R ~_ _ East QUARTER SECTION (check one): _ NE _ NW _ QUARTER/QUARTER SECTION (check one): _ NE _ NW _ New Mexico) Ute South / West SE / SW _ SE / SW GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): ~ ~ Mr r-es 10. Primary future (Post-mi4incl land use (check onel: _ Cropland(CR) _ Pastureland(PL) ,J~Rangelapd(RL) _ Forestry(FR) Residential(RS) _ Recreation(RC) _ Developed WaterResources(WR) 1 1. Primary present Isnd use (check onel: _ Cropland(CR) _ Pasturelapd(PL) 1[Rangeland(RL) _ Forestry(FR) _ Residential(RS) _ Recreation(RC) _ Developed Water Resources (WR) General Agricuhure(GA) _ WildlifeHabitat(WL) _ lndustriaUCommercial(1C) _ Solid WasteDisposal(WD) _ General Agriculture(GA) ,_ WildlifeHabitat(WL) _ lndustriaVCommercial{IC) _ Mining (MN) 12. If this operation will use designated chemicals, or will result, or presently has acid mine drainage -you cannot use this application form. You must submit either a 1 I Od or 112d application form for Designated Mining Operations. In either case, you must list any acidic or toxic-forming materials, exposed or disturbed as a result of the mining operation, and whether the operation wilt result in or presently has acid mine drainage: 13. Description of Amendment or Conversion: If you are amending or convening an existing operation, provide a brief narrative describing the proposed change(s):