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4 (Form 1 - All information for DRMS use and confidential filing) <br />5. Describe proposed surface excavation or other land disturbance, including roads, pits, trenches, waste piles, drill pads and <br />collar areas of underground workings, ponds, etc ... <br />One drill site (approx 20'X50) adjacent to and on an existing road. The site (WM-17-01) will not <br />require off road travel Only actual disturbance expected is for the D.O.E. mandated cuttings pit for the <br />drill site (see Section III-6-I below) No surface disturbance for the drill pad will be required and only <br />minor maintenance of the road will be necessary. Historic drill records indicate that the hole will be <br />dry. <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 1 Average width 20 (ft) Average Length 50 (ft) <br />B. Drill Holes: Quantity 1 Depth 600 (ft) Diameter 6 (in) <br />C. Mud Pits: Quantity 1 Average Width 10 (ft) Average Length 10 (ft) <br />Average Depth 3 (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 type, quantity and general dimensions: <br />None <br />D. Other Disturbances (please describe): <br />None <br />E. Indicate Chemicals and Fuels used or stored on site. List type, quantity and method to store. <br />Less than 200 gallons diesel fuel and 55 gallons or less of motor oil and/or hydraulic fluids used by <br />drill rips and support vehicles Fuel oils and fluids will be stored in the beds of the support vehicles <br />and removed from the drilling area at the end of each day. <br />F. New Road(s): Length (ft) Width (ft) <br />Significantly Upgraded Road(s) Length (ft) Width (ft) <br />Are culverts or other crossings proposed? If so, please describe: None Proposed