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,~~, <br />Y ~ ., <br />COLORADO DIVISION OF MINERALS AND GEOLOGY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />COAL EXPLORATION DRILL HOLE OR WELL ABANDONM~~T R~~ <br />~? <br />vision yMr:.erals and Cec: ~ „ <br />~, <br />This report is filed in accordance with Rule 4.07.3(3) of the Regulations of the Colorado Mined <br />Land Reclamation Board for Coal Mining, adopted in accordance with the Colorado Surface <br />Coal Mining Act, C.R.S. 3433-101 et seq. This report is to be submitted within 60.days of <br />sealing and plugging of all drill holes approved under the specific drilling program. This report <br />can be used for single or multiple holes and can be modified as needed, provided that the <br />information contained in Rule 4.07.3(3) is supplied. Additional sheets may be attached, if <br />necessary. <br />Notice of Intent No.: X - 200~~ 22C~ -OQ Date: T?~o5 <br />Project Name: _ /Jor'i'ftriEloL <br />Prospector: <br />Address: <br />County: <br />/~©r-(-h,-~'ie.1eL. ~ar-}'nea-5 , L-LG <br />P.O, Bo~C 2bo678 <br />L.~ii~le~on , C® 8oIb3-oG78 <br />/~r. Scv~ L.eonhart' <br />~re.moa..'f' <br />Name of Drilling Contractor: <br />License of DrYll and Rig: <br />Contractor Driller Name (print) <br />Signature <br />(Continued on Next Page) <br />