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DIVISION OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS <br />Limited Impact 110 Mining Operation <br />Application Worksheet/Checklist <br />New App: X Amendment App: <br />Operator: Phillips County / <br />Mine Name: Havnes Hereford Ranch Pit <br />Conversion App: <br />Mine H): M-2004-023 <br />Date Stamp Date: 03/26/2004 ~ <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />ITEMS <br />COMPLETED 1 2 3 4 5 6 <br /> X X X X X X <br />ITEMS 7 8 9 10 11 12 <br />COMPLETED Need General <br /> Location <br /> X X received X X X <br /> 04/06/2004 <br />ITEMS <br />COMPLETED CONY/AMEND <br />DE5CP PERMITEE <br />RESP SIG <br /> X X <br />MAPS and EXHIBITS (Rule 6.2) ADEQUACY COMMENTS <br />EXHIBIT A - 6.3.1 - LEGAL DESCRIPTION 6 LOCATION MAP X X <br />