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4 <br />5. Describe proposed surface excavation or other land disturbance, including roads, pits, trenches, waste piles, drill pads and <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: nr? e• L? <br />A. Drill Pads: Quantity Average Width (ft) Average Length (ft) <br />B. Drill Holes: Quantity Depth (ft) Diameter (in) <br />C. Mud Pits: Quantity Average Width (ft) Average Length (ft) <br />Average Depth (ft) <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 tvne. auantity and aPneral dir"Pncinnc• <br />D. Other Disturbances (please describe): <br /> <br />? 1' n 7 ` ' ,!1/ - - E. Indicate Chemicals and Fuels used or stored on site. List type, quantity and method to store. <br />?1 o 0 <br />F. New Road(s): t-ai4 Length on _e5S-__. (ft) Width Ito/6__ (ft) <br />Significantly Upgraded Road(s) Length (ft) Width ,((?__-(ft) <br />Are culverts or other crossings proposed? If so, please describe: __ A/Q n/e A <br />