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2- 6. Name of owner of theaubsurfaceri2htaofaffectedland: Keith & Shirley Ashbaugh 7. Name of owner of the aurface of affeMed land: Keith & Shirley Ashbaugh 8. Type of minnn¢ operation: X Surface Underground In-situ 9. Location iuformatiop: The center of the area where the majority of mining will occur: COUNTY: Weld PRINCIPAL MERIDIAN (check one): X 6th (C olorado) ] 0th (New Mexico) Ute SECTION (write number): S 15 TOWNSHIP (write number and check direction): T ~ ~ North South RANGE (write number and check direction): R 59 East X West QUARTER SECTION (check one): NE X NW SE SW QUARTER/QUARTER SECTION (check one): NE NW SE S W GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): 7 miles west of New Ravmer, south approximately 3 miles 10. Primary future (Poet-mipimtl land use (check one Cropl®d(CR) X Pastttreland(PL) _ Rangeland(RL) _ Forestry(FR) _ Residentiel(RS) _ Recreation(RC) _ Developed water Resottrces(WR) I ] . Primary present land use (check one): _ Croplmd(CR) g Pastttreland(PL) Rangeland(RL) _ Forestry(FR) _ Residential(RS) _ Recreation(RC) Developed Water Resottrces (WR) _ General Ag~iculture(GA) Wi]dlifeHabitat(WL) _ InditstriaUCommercial(IC) Solid WasteDisposal(WD) _ General Agriculture(GA) Wildlife Habita[(WL) IndustriaUCommercial(IC) _ Mmmg (MN) 12. If this operation will use designated chemicals, or will result, or presently has acid mine drainage -you cannot use this application Yorm. You must submit either a 1 lOd or t 12d application form for Designated Mining Operations. In either case, you must list any acidic ortoxic-fomung materials, exposed or disturbed as a result of the mining operation, and whether the operation will result in or presently has acid mine drainage: a Z 3. Descriptiop of Amendment or Copversioe: If you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s): n/a