PERMFILE127782

• Permit No: M1994096
• IBM Index Class Name: Permit File
• Doc Date: 11/21/1994
• Doc Name: LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

5-
city: InJ~II~ ~,c E o K

State:
C- U
Zip _
Code: ~ C/S y
Area Code : Z n ~ Telephone : .J`- Co Q - .3 S.S !
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name: ~ ~ Title:
Company Name: O~S., '1; . ~r'c%-~' . S ~-. v
Street:
City:
State: Zi _ o e:
~
Area Code: Telephone: ~ ~ ~ /
`~~' ~ '
INSPECTION CONTACT l~~
Individual's Name: S 4 .~( ~ '(
Company Name
Street:
City:
State: Zip Code:
Area Cade: Telephone:
Agenry:
Street:
City:
State:
Area Code:
Agency:
Street:
City:
State:
Area Code:
Zip Code:
Telephone:
Zip Code:
Telephone:
11. Primary future (Poet-mining) lead use (check one):
11 CC=op~aad(CR) _ Paetureland(PL) _ General Agriculture(GA)
_ Rangeland(RL) _ Porestrx(FR) _ Wildlife Babitat(WL)
Residential(RS) RecreatioalRC) Industrial/Cammercial(IC)
_ Developed Water ~esourcea(WR) = Solid Waste Dieposal(WD)
12. Primary greaent land uee (check one):
~( Cropland(CR) Paetureland(PL] _ General Agriculture(GA)
_ Rangeland(RL) _
_ Forestry(FR) _ Wildlife Habitat(WL)
_ Resideatial(RS) Recreation(RC) industrial/Commercial(ZCI
Developed Water Resourcee(WR) _ Miaiag(MN)
I3. If this operation will use desigoated chemicals, or will result, or presently has
acid mine drainage - you cannot uee this application form. You must submit a either
a 110d or 112d application form for Designated Mining Operations. In either case,
you must list any acidic or toxic-forming materials, exposed or disturbed ae a
result of the miaiag operation, and whether the operation will result in or
presently has acid mine drainage : ~~ n „ .. ~ . ~ ~ ~ w / o .,. 2 /.~ ~. ,,,1~
Description of Conversion:
If you are converting an existing operation, provide a brief narrative describing the
proposed change(s). ~}-
Na Exhi it /v / ! '
S it two (2) cou~plete, ++~~•~d copies of the following application exhibits:
6.3.1 S]O{ZBIT A - Legal Description sad Location Map
6.3.2 fiXtIiBIT 8 - Site Description