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, <br />LIMITED I III ~IIIIIIIIIIII'll 10(2)) <br />RL__.. sss <br />APPLICATION FORM <br />CHECK ONE: New Application (Rule 3.2) Amendment Application (Rule 1.8) <br />_ Conversion Application (Rule 1.10) <br />The application for a Limited Impact Operation Reclamation Permit contains three major <br />parts: Ci) the application form; <2) Exhibits A-J; and, (3) the application fee. When <br />you submit your application, be sure to include one (i) sinned original and one (1) copy <br />of the application form, two (2) copies of Exhibits A-J, and a check for the application <br />fee described under (3) below. To expedite processing, please provide the information <br />in the format and order described in this form. <br />eaaazzaaaaaaazasazacazxzazszsaxxazaazzxzszaexs:aaxssaxxaasaoezxaaaxx_esaaxxoxxeeaaaxxavxs <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />asaszaaazzaaazaaaaszzaazxaaaasaazaaazaaaa:sassaaxzzoazsaaxazaazssaazsazzaaszazxasaaxxaaca <br />Applicant/operator name: <br />e_ <br />Cor, <br />1.1 Type of organization (corporation, pa~rltnership, etc.>: ('or ora"~.io,~ <br />2. Operation name (pit, mine or site name): ~er~(~nu d ~uylSe~ <br />2.1 I.R.S. Tax ID No. or Social Security No.: 53'-I- I l rl- `f q I F"~ <br />3. Permitted acreage q, q 9 8 permitted acres <br />3.1 Application Fee (New Application Only) $875.001I application fee <br />4. Substance(s) to be mined (e.g., gravel/gold/borrow): ~,~ Vi d .C ~ 0 K C'. <br />5. Name of owner of surface of affected land: 1NeI ~ e ~.~r-CIS J~ ~~ra~ue <br />6. Name of owner of subsurface rights of affected land: IV.ei 1 ~ ~ ~-r~it /!?, S~:~J~gtf4e <br />7. Type of mining operation: ~ Surface _ Underground _ In-situ <br />8. Location information. The center of the area where the majority of mining will <br />occur lies in: II o <br />COUNTY: 1.Q r t isle r <br />PRINCIPAL MERIDIAN (check one): ~( 6th <br />TOWNSHIP (write number and check direction) <br />RANGE (write number and check direction): <br />SECTION (write number): <br />QUARTER SECTION (check one): <br />QUARTER/QUARTER SECTION (check one): <br />GENERAL DESCRIPTION: <br />(miles and direction <br />(Colorado) 10th (New Mexico) Ute <br />T ~ ~ North South <br />R 2'~ _ East ~ West <br />S <br />NE NW ~C SE SW <br />NE _ NW _ SE _ SW <br />from nearest town and <br />approximate elevation) <br />~-~ <br />