PERMFILE137121

• Permit No: C1981016
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Doc Name: Cultural Survey
• Section_Exhibit Name: APPENDIX D
• Media Type: D
• Archive: No

COLORADO BL'N ARCHAEOLOGICAL SURVEY
STTE INVENTORY RECORD
Thie information to be filled in by site recorders
' 1) site No.5~1I254') project name Ylestern Slope Carbon 3) SLM district tiontrose
• 4) sesouree area Uncompahgre Basin 5) planning unit North Fork 03-02
6) surface management quad Paonia Reservoir (NYI-27)
7) heritage value (does the site have special significance for ethnic groups in the
areaY) yes_ no R
This information to be filled in by district archaeologist:
8) case file or contract No.
9) surface owner: BL"t other Federal ` State _ private
10) subsurface ownership (does BLM have responsibility) yes_ no_
11) grazing unit 12)HMP unit
13) segregation (type)
14) mining claim recordation: yes_ no 15) mineral agency
•16) mineral owner
17) mineral part owner
18) mineral lease 1 19) mineral lease 2 _
20) future potential S1 S2_ S3_ S4_
21) conflicts:
wildlife
watershed
minerals
range
recreation
forestry
lands
22) mitigation: avoid map collect test~artially excavate_excavate_
• 23) District Archaeologist's signature