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-2- <br />PSiaffTTING CONTACT (if different from applicant/operator above) <br />Individual's Name: - Title <br />Company Name: <br />Street: <br />City: <br />State: Zip Code: <br />Area Code: Telephone: <br />INSPfiCTION CONTACT <br />Individual's Name: Lee 6utherland <br />Company Name: ut er an ros., nc. <br />Street: 29703 HWY 97 <br />City: Nucla_ <br />State: Cnlo adn Zip Code: X1424 <br />Area Code: 970 Telephone: 864-7662 <br />Agency: ivviv c <br />Street: <br />Caty: <br />State: <br />Area Code: Telephone: <br />CC• STATS OR FfiDfiRAL LAfIDOWA&R (if aav) <br />Agency: <br />Street: <br />City: <br />State: zip Code: <br />Area Code: Telephone: <br />11. Primary future (Post-m+^+^g) land use (check one): <br />Cropland(CA) _ Pastureland(PL) General Agriculture(GA) <br />Rangelaad(RL) _ Forestry(FR) _ Aildlife Iiabatat(NL) <br />Resadeatial(RS) _ Recreataon(RC) Industrial/Commercial(IC) <br />_ Developed stater Resources(flR) = Solid Waste Di~po~al(1~) <br />12. Primary uresent load use (check one): <br />Croplaad(CR) _ Pastureland(PL) _ General Agriculture(GA) <br />~C Rangelaad(RL) _ ForestrX(FR) ~iildlife Habitat(AL) <br />Resadential(RS) Recreataon(RC) _ Industrial/Commercial(IC) <br />= Developed stater Resources (iiR) _ Mining (PIlP) <br />13. If this operation will use designated chemicals, or Hill result, or presently has <br />acid mice an+^aqe - you cannot use this application form. You moat submit a either <br />a 110d or 112d application farm for Designated Mining Operatiana. In either case, <br />you moat list any acidic or toxic-forming materials, exposed or disturbed as a <br />result of the ~~^+^g operation, and rhether the operation rill result in or <br />presently has acid mine ~~+^~^~: No chemicals will be used in the operation <br />DeaCZ'1DtlOn Of COnVer'91OII: <br />If you are oanvertaag as exiatiag operation, Provide a brief ^=+~+~tive describing the <br />proposed change(s). <br />Move ti ~d~ibits- <br />Suhmit two (2) complete, unbound copies of the following applicaticn exhibits: <br />6.3.1 >3~IT A - Legal Description and Location Map <br />6.3.2 1~IT B - Site Description <br />6.3.3 Ji~IT C - Mining PTaa <br />6:3.4 AZT D - Reclamation Plan <br />6.3.5 1~IT 8 - Maps <br />6.3.6 SB7~IT F - Liet of Other Pezmita and Liceaaes Required <br />Zip Code: <br />