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IMITED IMPACP OPBRATION (110(2 ReC21VEf~ <br />RBCLAMATION PBRMIT <br />• APPLICATION FORM EE~ 00 ~1 <br />CHECK ONE: X New Application (Rule 1.4) _ Amendment Applicationo(C~R~S6 ~Y~92.5.110) <br />Conversion Application (Rule 1:11) DurangpFie(dOry)cg <br />Divlalon of Minerals & Gaotop~~yy <br />Permit # M-- - (pro~de for amendments and conversidhs of <br />existi~q permits) <br />'the application fora Limited Impact Mining Operation Reclamation Permit contains three major <br />parts: (i) the application form; (2) Exhibits A-J, Addendum i, any sections of Exhibit S and <br />Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules 6.1, 6.2, <br />6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your application, be sure <br />co include one (1) sioned and notarized original and one {1),copy of the application form, <br />two (2) copies of Exhibits A-J, appropriate sections of 6.4.19 Exhibit S and 6.5 <br />(Geotechnical Stability Exhibit), as required, and a check for the application fee described <br />under (a) below. Exhibits should not be bound or in a 3-ring binder; maps should be folded <br />to 8 1/2" X il" or 8 112" X 14" size. To expedite processing, please provide the information <br />in the format and order described in this form. <br />----- ------ - -- -- ------ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/operator or company name (name to be used on permit): <br />].1 Type of organization (corporation, partnership, etc.): CO oration <br />1.2 I.R.S. Tax ID No, or Social Security Number: <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (~ or -) <br />Total Acreage in Permit Area <br />4, Fees: <br />4.1 <br />4.2 <br />Ophir Lode <br />9.84 permitted acres <br />acres <br />9 • acres <br />New Application 5875.00 application fee <br />Amendment Fee (C.R.S. 34-32,5-125(II)) 5575.00 application fee <br />Conversion Fee (from li0d to 110 875.00 conversion fee (Rule 1.11.2(21) <br />S. Primary commoditie(s) to be mined: S11Ver G01d Lead Zinc Copper <br />6. Name of owner of the subsurface rights of affected land: Ophir-Nevada, InC. <br />~. Name of owner of the surface of affected land: Ophir-Nevada, InC. <br />8. Type of mining operation: Surface X IInderground Tn-situ <br />9. Location information. The center of the area where the majority of mining will <br />occur lies in: Hinsdale <br />COUNTY: <br />PRINCIPAL MERIDIAN (check one): 6th (Colorado) ~ 10th (New Mexico) IIte <br />SECTION (write number): S 20 <br />TOWNSHIP (write number and check direction): T R North South <br />RANGE (write number and check direction): R East X west <br />QUARTER SECTION (check one): NE NW SE SW <br />QUARTER/QUARTER SECTION (check one): NE ~ NW SE SW <br />GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and <br />the approximate elevation) Capito es east. 11,200 feet <br />elevation at mine adit <br />