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• i _2_ 6. Name of owner of the subsurface ria~tts of affected land) ~-~-Af'e ~1"-~I~(c~1o 7. Name of owner of the surface of affected laced: ~'A~'e ~~ ('~~~r[lL1n a. Names of the holders of any recorded easements on the affected land: _~~~ _ 8. Tvoe of mining operation: ~ Surface IInderground In-situ 9. Location information. The center of the area where the majority of mining will occur: COUNTY: PRINCIPAL MERIDIAN (check one): ~ 6th (Colorado) SECTION (write number): S ~~ TOWNSHIP (write number and check direction): T 1~ RANGE (write number and check direction): R ,~Q~_ QUARTER SECTION (check one): QUARTER/QUARTER SECTION (check one): NE NE 10th (New Mexico) Ute North x South _ East ~ West _ NW SE ~ $W -_ NW SE Sw GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation) : ].J- 1Y111f-~ I\iflf i'Y~ ~ rt'PYl'fd~P_ \'1~ _ ON ~itlt'P~ 11'l~ ~LZ~4CY~ ~r+. 10. Primary future (Post-mining) land use (check one): _ Cropland(CR) Pastureland(PL) General Agriculture(GA) _ Rangeland(RL) Forestry(FR) ~ Wildlife Habitat(WL) _ Residential (RS) Recreation(RC) Industrial/Commercial (IC) _ Developed Water Resources (WR) Solid Waste Disposal (WD) 11. Primary present land use (check one): _ Cropland(CR) Pastureland(PL) General Agriculture(GA) _ Rangeland(RL) Forestry(FR) ~ Wildlife Habitat(WL) . _ Residential(RS) Recreation(RC) Industrial/Commercial(IC) Developed Water Resources (WR) Mining (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 Mining 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: 13. Deecrintioa of Amendment or Coavereioa: If you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s):