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• iii iiiiiiiiiiiii iii • <br />999 <br />DIVISION OF MINERALS AND GEOLOGY <br />Limited Impact 110 Construction Materials Operation <br />Application WorksheeUChecklist <br />New App: / Amendment App: <br />Operator: Siloam Stone <br />Mine Name: Pinon Mine <br />Conversion App: <br />Mine ID: M-97-094 <br />Submittal Date: 10/14/97 <br />APPLICATION FORM (Rule 1.41 <br />APPLICATION ITEMS COMPLETED <br />------1------- ------ ~ ------ ------ 3 ------ ------ 4 ------ ------ 5 ------ ------ 6 ------ ------~ ------ <br />/ / / / / / / <br />------ S ------ ------ 9 ------ ----- 1 ~ ----- ------11------ ----- 1 ~ ----- ----- 13 ----- -----14------ <br />/ / / / / / / <br />____Initials____ __ S~nature __ ___ Notices ___ COMMENTS: <br />/ / / <br />EXHIBITS <br />----- A------ ------8------ ------C------ ------~------ ------E------ ------F------ ----- -C'------- <br />/ / / / / / OK <br />H I J L Geotech Sign Affid. <br />/ / / / / <br />COMPLETENESS COMMENTS: <br />