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DIVISION OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS <br />Regular (112) Mining Operation <br />Application Worksheet/Checklist <br />New App: / Amendment App: Conversion App: <br />Operator: Moffat county / Mine ID: M-2oo5-006 ~ <br />Mine Name: Poxdenrash Pit No. 66 / Date: 02/17/2oo5 / <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />ITEMS <br />COMPLETED 1 2 3 4 5 6 <br /> / / / / / <br />ITEMS <br />COMPLETED 7 8 9 10 11 12 <br /> / / / / / <br />ITEMS 13 14 Description Responsibilities Signature <br />COMPLETED of Of a Application to <br /> Amendment permittee be re-notarized <br /> / / / <br />MAPS and EXHIBITS (Rule 6.2) <br />EXHIBIT A - 6.4.1 - LEGAL DESCRIPTION: / <br />ADEQUACY COMMENTS <br />EXHIBIT B - 6.4.2 - INDEX MAP: / <br />