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<br />Form 2 (Public File) <br />NOTICE OF INTENT TO CONDUCT PROSPECTING OPERATIONS <br />FOR HARD ROCK/METAL MINES <br />CHECK ONE: There is an NOI Number Already Assigned to this Operation <br />NOI # P- - (Please reference the file number assigned to this operation) <br />New NOI <br />Modification to an Existing NOI <br />NOW P- - (Provide for Modifications to an existing NOI) <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. GENERAL INFORMATION <br />1. DATE NOT RECEIVED BY THE DIVISION: office use onl <br />2. PROJECT NAME: J 'cam <br />3. PROSPECTOR: <br />/', <br />Name:! <br />Title: I'vkao4.e- -__- <br />Company Name: <br />Street: -Al <br />P.O. Box: / _7:?9 <br />City: <br />State: e' Zip Code: _ el,230 <br />Telephone Number: <br />Fax Number: <br />PERSON MLRB SHOULD CONTACT: <br />Name: <br />Title: <br />Company Name: _ a <br />Street: /,z0 Al <br />P.O. Box: <br />City:irsr,isc>, _ <br />State: <br />Gip Code: 81-230 <br />Telephone Number: 7a.-b"i/- <br />Fax Number: f76 6 y/- 5'9-zo <br />4. APPLICATION FEE: $86. (NOis require a $86 fee which must accompany this notice or it cannot be processed by the <br />Division). <br />5. LOCATION INFORMATION: <br />County ?,? „iso>. W W_ <br />PRLNICIPAL MERIDAN (check one) _ 6'h (Colorado) _ lpd' (New 4lexico) (Ute) <br />SECTION (waste number): S S`-