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4 (Form 2- Public) <br />5. Describe proposed surface excavation or o#her land disturbance, including roads, pits, trenches, waste piles, drill pads and <br />collar areas of underground workings, ponds, etc... <br />6. Proposed Disturbance {approximate) Describe the proposed drilling to be conducted, including anticipated number of holes, <br />diameter, depth, location, etc... Submit additional pages if necessary: <br />A. Drill Pads: Quantity Average Width <br />B. Drill Holes: Quantity Depth <br />C. Mud Pits: Quantity <br />Average Depth (ft) <br />(ft) Average Length ~~ (tt) <br />(ft) Diameter <br />Average Width (ft) Average Length <br />_(th) <br />(~) <br />Described proposed underground work, including reopening of old workings, advancement of adits or shafts, <br />trenches, pits, cuts, rock dumps, or other types of disturbance, describe type, quantity and general dimensions: <br />D. Other Disturbances (please describe): <br />E. Indicate Chemicals and Fuels used or stored on site. List type, quantity and method to store. <br />F. New Road(s): ~tJD/,~ Length (ft) t'Vidth (ft) <br />Significantly Lpgraded Road(s) Length ~. {ft) Width (ftj <br />Are culverts or other crossings proposed? If so, please describe: /l/U <br />