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MINED LAND WILDLIFE QUESTIONAIRE <br />For Limited Impact and Select Regular Mine Applications <br />1. Name of Company/Mine: WESTERN Mebilt S o-u~~ ~ntc. ~ Q Sot BS~Olhr~ <br />'~F LAFa,RUe GoR~-' $EEMk~ ~ ~~c- P IT <br />2. Name/Address/Phone of Contact Person: E .P-1~' R~LK-~~1TIrJE ~ <br />I59a W. 12*" lkv6. <br />~yc-~ Lo 802e4 .3 03- ~5~- ~E33o <br />r W ~2 <br />3. Location of Mine: pUE. BL~~T2.lS, RjP3W F4 S~q NW~~453 ~,SE%q.Sji <br />(County, Township, Range, Sectionn & Quarter Section) <br />4. Nearest Town/General Location: VlnlEj~~f~ <br />5. Land Ownership(Circle) 1. Privat 2. BLM 3. USFS 4. SLB <br />5. Other <br />6. Present Land Use: ~.krlG-tEL.kNQ <br />7. Proposed Final Land Use: ~M•1faFiL.MJI~ <br />8. Type of Operation: 1. Surface 2. Underground <br />9. Minerals Being Mined:~2~la.t~TF. <br />10. Number and Description of Surface Acres Disturbed by Mining <br />(Not including roads) : ~~ a~a maY••rnoM <br />11. Miles of roads to be constructed: 2- rti>a,~.~w, <br />12. Life of Mine (years): o ~ <br />13. Description of Operation and Reclamation (Additional sheets may <br />be attached)~~Q .}4~1~~ r'`aP5 c-~d [„~L~`,t{~~~. <br />14. Please enclose Maps of Project Operation, Disturbance Areas <br />and Reclamation. This will expedite processing. <br />15. Prepared by: Lc~~ ~4~~<w.~;..2.. Date: as y~~~ Zood <br />Page 1 of 2. <br />