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T ~ ` ~ i -z- Name of owner of the subsurface rights of affected land: '1/. ci; ~i i%u Y 7. Name of owner of the surface of affected land: (~- ~~!i c~ir i 7.1 Names of the holders of any recorded easements on the affected land: 1%rtiL~, 6. Type of miaiag operation: / Surface Underground In-situ 9. Location iaformatioa: The center of the area where the majority of mining will occur: COUNTY: ~Li ~.(~"- PRINCIPAL MERIDIAN (check one): /6th (Colorado) 10th (New Mexico) Ute SECTION (write number): /~) ~ 1~:~ TOWNSHIP (write number and check direction): RANGE (write number and check direction): QUARTER SECTION (check one): QUARTER/QUARTER SECTION (check one): g /~i t 2<~ T ~~1 North ~~ South R ~/ ~ East ~'~West NE NW ~ SE SW NE NW / SE SW GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): /~i% it; i•/~ ,~,•i •~(// f=~ /. '•`,i/(~h ~lC. ~.. 10. Primary future (Poet-wising) land use (check one): • Cropland(CR) ~Rangeland(RL) Pastureland(PL) Forestry(FR) General Agriculture(GA) Wildlife Habitat(WL) _ Residential(RS) ~ Recreation(RC) Industrial/Commercial(IC) _ Developed Water Resources(WR) Solid Waste Disposal(WD) 11. Primary present laced use (check one): _ Cropland(CR) Pastureland(PL) General Agriculture(GA) 1/ Rangeland(RL) Forestry(FR) Wildlife Habitat(WL) Residential(RS) Recreation(RC) Industrial/COmmercial(IC) Developed Water Resources (WR) Mining (MN) 12. If this operation will use designated chemicals, or will result, or presently has acid mine drainage - you cannot use this application form. You must submit 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 as a result of the mining operation, and whether the operation will result in or presently has acid mine drainage: ~c~EC AJ~~1- a.(~lv 13. Description of Amendment or Coaversioa: If you are amending or converting an existing operation, provide a brief narrative describing the proposed change(s):