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a Q? gv? <br />4 (Form/- filing) <br />All in d eenfidentir-A 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 />1 l? frb !v(1 G C Z ? l [ C) R?S Lc5 i X11. si <br />!l tiorp Lott <br />T=<?, 6 em.- -F; -Tc) 0 ortu2&L <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 (ft) Average Length (ft) <br />B. , Drill Noles:nQua ity Depth (ft) Diameter (in) <br />C MMud lt'i`J33 1 Qu it y Average Width kl?)6 (ft) Average Length (ft) <br />Average Depth i <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 />LA?,' e- k) a 440 tl? 9' 4;k91 <br />cr-- W?1etS '0 l? -?: T t i> r 1"# lo ,P? A-? <br />i01 ?--d -41" t_ P ?J `,-h <br />0` S <br />O-Owpi <br />D. they Disturbances (p as de cr <br />L} 1U e?) P ? W i (t O t1 S _ i tt- _ _,fJ A C? <br />E.. Indicate Chemicals and Fuels used or stored on site. List type, quantity and method to store. <br />CoM m? <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 o, please describe: