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-a- 6. Name of owner of the subsurface rights of~affected land: 7. Name of owner of the surface of affected land: `5- ~ ~ v 8. Tune of mining operation: X Surface Undergr and In-situ 9. Location information. The center of the area where the majority of mining will occur: coaNTY: l~A R K PRINCIPAL HERIDIAN (check one): ~ 6th (Colorado) 10th (New Mexico) Ute SECTION (write number): TOWNSHIP (write number and check direction): RANGH (write number and check direction): QIIAI2TER SECTION (check one): QUARTER/QUARTER SECTION (check one): S _~ T /3 North X South R ~ East ~ West NE NW SE X SW __ NE ~ NW SE SW GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation) : Tiff Pir /s i4i/20Y R ~ M /tE S SOari+ Ei+sr By ~/hRTS E ~+ !}NO ~S /T~PROX 5700 FFET A60yF SEA J.EVF_L 10. Primary future (Post-mining) land use (check one): _ Cropland(CR) Paetureland(PL) General Agriculture(GA) Rangeland(RL) Forestry(FA) Wildlife Habitat(WL) Resident ial(RS) Recreation(RC) Industrial/Commmercial(IC) Developed Water Resources(WR) Solid Waste Diaposal(WD) 11. Primary present land use (check one): Cropland(CR) Paetureland(PL) General Agriculture(GA) ~_ Rangeland(RL) Forestry(FR) Wildlife Hab itat(WL) Reeidential(RS) Recreat ion(RC) Industrial/Commercial(IC) Developed Water Resources (WR) Hining (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 110d or 112d application form for Designated Hining 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 will result in or presently has acid mine drainage: No CHEM/fA.CS 1~1//~L ~E G~SEb 13. DescriDtioa of Amendment or Conversion: If you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s):