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' l~ED LAND WILDLIFE QUESTIONNAIRE • <br />~; For Limited Impact and Select Regular Mine Applications <br />1. Name of Coa.pany/Plinc: <br />2. Name/Address/Phone of Contact Person: ~-~/~}?~n ~. C(_A f ~ ~,$')-~~ Z (- <br />-~~1 ~~LOg2S5PrNl~C~i~O ~I)b'/c. <br />3. Location of lfine: <br />(County, 7'otmship, Range, Section to nearest quarter quarter; Exhibit A-}fLR appl.) <br />4. Nearest ToGm/General Location: ~=/~~SS~4 N T <br />5. Land Ownership (Circle) Q Private 2. SLM 3. USFS 4. Ocher <br />6. Present Land Use: Q- I <br />7. Proposed Final Land Use: ~Al~,i C.Qf~.t~(1 <br />8. Type of Operation: 1~. Surface 2. Underground _ <br />9. Alinerals bf:ing mined: _~~) .~- (;(~p~//'f <br />20. Nuaber and Description of Surface Acres Disturbed by Mining/not including roads <br />(Exhibic D-:II.R) : .3,5 !~I-RL--.~ <br />11. Miles of reads to be constructed <br />12. Life of *tine (years): <br />13. Description of Operation and Reclamation -- Additional sheets may be attached <br />(E>:hibi[s 13 S E-MLR) <br />i 14. :Please enclose Maps of Pro]ect Operation, Disturbance Areas and Reclamation (E>:hSbit <br />' C.) This.will expedite processing. Your cooperation is appreciated. <br />I5, Prepared by: <br /> <br />Date: <br />Parr 1 of 2 <br />