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• s <br />_Z_ <br />3. Address and Phone Number of <br />Local Offices <br />Phillips County Shop, 420 W. Denver, Holyoke, CO 80734 854-3529 <br />4. Address and Phone Number of <br />General Offices <br />5. Name and Phone Number of Person <br />Staff Members Should Contact <br />CO 80734, 854-2454 <br />Commissioner Larry Haynes, Rt. 1 Box 42 Holyoke CO 80734 <br />6. Owner(s) of Record of Affected Land <br />(surface area) (If more than 2, list below) <br />Austin Hereford Ranch <br />1. Owner(s) of Substance to be Mined <br />(If more than 2, list below) <br />Austin Hereford Ranch <br />8. Source of Legal Right-To-Enter <br />(Indicate what type of proof is <br />included in EXHIBIT G - lease, <br />deed, notarized letter, etc.) <br />Notarized Letter <br />9. Type of Mine and Substance to be Mined <br />(Specify underground, open pit, <br />quarry, etc. & substance(s) to <br />be mined) <br />Open Pit - Sand, Clay, and Gravel <br />10. General Location and Elevation <br />(Miles & direction from nearest <br />town & approximate site elevation) <br />11 Miles N and 6; Miles F.asr of Holyoke Elevation 3970 <br />11. County <br />12. Acreage of Affected Lands <br />(Total surface acreage to be <br />included in permit) <br />13. Application Fee (See applicable <br />Rule to determine amount) <br />Waived h~_~qi slature for roan i es <br />