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<br /> <br />Appendix A. <br />APPLICANT'S QUESTIONNAIRE TO THE COLORADO DIVISION OF WILDLIFE <br />For Limited Impact Operations <br />(Permit 110-1 and 110-2) or <br />Regular Operations Permit 112) <br />Instructions to the applicant: Complete both sides of this form. Send the <br />completed form to a-tom appropriate Division of Wildlife (DOW) Regional Manager. <br />~ional Managers• <br />W Region: 7Tndependent Avenue Grand Junction, CO 81505 <br />NE Region: 317 W. Prospect Avenue Ft. Collins, CO 80526 <br />Central: 6060 Broadway Denver, CO 80216 <br />SW Region: 2300 S. Townsend Avenue Montrose, CO 81401 <br />SE Region: 2126 N. Weber Colorado Springs, CO 80907 <br />To expedite processing, please provide the information in the format and order <br />described in this form. Type or print clearly. Incomplete questionnaires will be <br />returned. Please allow 30 days for processing of completed form. Your cooperation <br />is appreciated. <br />PLEASE ATTACH THE FOLLOWING INFORMATION TO THIS FORM: <br />A. Mining and Reclamation Plan: Description of proposed reclamation plan or <br />su~init Mining and Reclamation Plan as prepared for MLRD application. <br />B. M~apps: Submit copies of maps for the both the Mining Plan and the Reclamation <br />PIan. Suggested maps are those prepared for the MLRD application. <br />For the 110-1 Permit, Two Acre Limited Impact Operation: Exhibit A - Location <br />Map Exhibit C - Affected Lands Map. <br />For the 110-2 Permit, Limited Impact Operation: Exhibit E - Mining Plan Map <br />and Reclamation Plan Map. <br />For the 112 Permit, Regular Operation: Exhibit C - Pre-Mining and Mining Plan <br />Map(s) of Affected Lands, and Exhibit F - Reclamation Plan Map. <br />- - - - - - - - - - - - - - - - - - - - - - - <br />1. Operation name (pit, mine): ti illard Yit ff2 <br />2. Application type (check one): Two Acre Limited Impact Operation (110-1) <br />Limited Impact Operation (110-2) <br />~-Regular Permit Operation (112) <br />3. Name of applicant/operator [w;offat County hoad Uepartrnent <br />Address: r'. U. F3ox 667, Craig, CO 81626 <br />Phone Number: (970)824-3211 <br />4. Name of contact person (if different from above): b.arvin b.oore (Consultant) <br />Address: 1570 kanney Wit. Craig, CO 131625 <br />Phone Number: (970) 824-9249 <br />5. Location of mine: l+~offat County - 210IV, 1:90+J of 6th, section 31 (S~;Br,) <br />(County, Township, Range, Section to nearest quarter quarter <br />(OVER) <br />_10_ EXHIBIT H-2 <br />