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~II ~I~~I~~I~~~~~~I~ • LIMITED IPirn~,i vr~9iv~iavn ~i10(2)) RECLAMATION PERMIT APPLICATION FORM R~LEIVE.; MAR 17 1993 Oivrsrun ~i iw,nerais ~ ~, ~ay CHECK ONE: ~ New Application CRule 3.2> Amendment Application (Rule 1.8) Conversion Application (Rule 1.10) The application for a Limited Impact Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A-J; and, (3) the application fee. When you submit your application, be sure to include one C1) si ned original and one (1) copy of the application form, two (2) copies of Exhibits A-J, and a check for the application fee described under (3) below. To expedite processing, please provide the information in the format and order described in this form. ~_ ~ 3_ ~ ~ ~ ~3 ~ 2_-- -- - -°---- GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. a~ a ~ a a-3 i 3 1. Applicant/operator ndme: Mike Coleman and Jerry Seifert 1.1 Type of organization (corporation, partnership, etc.): Part.nP ~h;~ 2. Operation name (pit, mine or site name): sr-hoolf;eia Pit 2.1 I.R.S. Tax ID No. or Social Security No.: Na-iiaRai4 3. Permitted acreage 9.98 permitted acres 3.1 Application Fee (New Application Only) 5875.00 application fee 4. Substance(s) to be mined (e.g., gravel/gold/borrow): travel 5. Name of owner of surface of affected land: Mika ('nlaman ana T v s ;f rt 6. Name of owner of subsurface rights of affected land: M;xP cnleman s ,Terry sP;fert 7. Type of mining operation: ~ Surface _ Underground _ In-situ 8. Location information. The center of the area where the majority of mining will occur lies in: COUNTY: Custer PRINCIPAL MERIDIAN (check one): ~ 6th (Colorado) _ 10th (New Mexico) _ Ute TOWNSHIP (write number and check direction) : T ~~C _ North ~ South RANGE (write number and check direction): R ~~ _ East ~ West SECTION (write number): S ~ QUARTER SECTION Ccheck one): NE ~ NW SE SW QUARTER/QUARTER SECTION Ccheck one>: _ NE _ NW _ SE ~ SW GENERAL DESCRIPTION: (miles and direction SPV~n m;i PS coy h of ~~ ~. l;ffe, oa t. an from nearest town and approximate elevation) elevation of approximately 9,000 feet.