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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 t_h_e_ applicant: Complete both sides of this form. Send the <br />complefe3~orm o et(i appropr3a~e Division of Wildlife (DOW) Regional Manager. <br />Regional Manace~rs: <br />FlFl~ion: 71T-Independent 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 5. Townsend Avenue Mgntrose, 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 Porm. Your cooperation <br />is appreciated. <br />PLEASE ATTACH THE FOLLOWING INFORMATION TO THIS FORM: <br />A. Minin and Reclamation Plan: Description of proposed reclamation plan or <br />su it M Wing and Rec amation Plan as prepared for MLRD application. <br />B. Ma s: Submit copies of maps for the both the Mining Plan and the Reclamation <br />~. Suggested maps are those prepared for the MLRD application. <br />For the 110-1 Permit, Two Acre Limited Lnpact 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 />Maps} of Affected Lands, and Exhibit F -Reclamation Plan Map. <br />- - - - - - - - - - - - - - - - - - - - <br />1. Operation name (pit, mine): Powderwa.sh r^it IVo. 66 <br />2. Application type (check one): Two Acre Limited Impact Operation (110-1) <br />Limited Impact Operation (110-2) <br />~xxxx Regular Permit Operation (112) <br />3. Name of applicant/operator: P~offat County Road Department <br />Address: P.G. Box 667, Craig, CO 81625 <br />Phone Number: (970) 824• 3211 <br />4. Name of contact person (if different from above): Marvin Moore (Consultant) <br />Address: 1570 Ranney 5t., Craig, CO 81625 <br />Phone Number: (970) 821+-9249 <br />5. Location of mine: Moffat T11N, R97W Section 25:SESW & St~dSE <br />(County, Township, Range, Section to nearest quarter quarter <br />(OVER ) Exhibit H-1 <br />-lD- Wildlife Information <br />