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OF' COIO <br />Ne/_ ,. \~ <br />.~F':' <br />;~; COLORADO DIVISION OF MINERALS AND GEOLOGY <br />" rays ` 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />RECEIVE[? <br />NOTICE OF INTENT TO EXPLORE INVOLVING REMOVAL OF <br />250 TONS OR LESS OF COAL 0 CT 2 R 2005 <br />PART I Division of+rlinerals & Geology <br />Notice of Intent No. (Assigned by Division): ~ t~5 - 1 ~ ' ~a <br />Applicant: ~~~LCoT7 ~NrdGt~ <br />Project Name: .l~d.S - ~d <br />Date: (/G~ ~~45 Commodity Mined or Explored: o <br />Mineral Ownership: Federal ~ State ~ Private <br />Surface Ownership: Federal ~ State ~ Private <br />Permittee / <br />Individual's Name: C ~i/~ Tif~oiA <br />Company Nay <br />Address: <br />Telephone: (9To1 ~~9- /373 <br />Permitting Contact (if different from above) <br />Individual's Name: <br />Company Name: <br />Address: <br />Telephone: <br />Inspection Contact (if different from above) <br />Individual's Name: <br />Company Name: <br />Address: <br />Telephone: ~_ <br />NOTE: Exploration must be conducted in compliance with the Rules and Regulations of the Colorado Mined Land <br />Reclamation Boazd for Coal Mining, adopted in accordance with the Colorado Surface Coal Mining <br />Reclamation Act, C.R.S. 34-33-101 et sec . This form must be filled out entirely before it can be considered <br />complete. Two (2) copies of this Notice, including maps and additional attachments, should be submitted to the <br />Division of Minerals and Geology. Please refer to Rules 2.02, 3.05, 4.07, 4.21 and 5.01 for specific regulatory <br />requirements. <br />