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<br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />C O L O R A D O <br />Denver, Colorado 80203 DIVISION O F <br />Phone: (303) 866-3567 RECLAMATION <br />FAX: (303) 832-8106 MINING <br /> <br /> SAFETY <br />Bill Ritter, Jr. <br />MINERAL PROSPECTING DRILL HOLE Governor <br />PERMANENT ABANDONMENT FINAL REPORT Harris D. Sherman <br />Executive Director <br />Ronald W. Cattany <br />Division Director <br />Natural Resource Trustee <br />Pursuant to the terms of 34-32-113(5.5)(d) and (e) of the Act, all information provided in this report shall be protected <br />as confidential information by the Mined Land Reclamation Board and shall never be a matter of public record. <br />Prospect Site Name: <br />Drill Hole I.D. No. <br />Date Drilled: <br />Prospect NOI No.: P- - <br />OPERATOR: (PROSPECTOR) <br />Name: <br />Address: <br />City: <br />Telephone No.: <br />St.: Zip: <br />Address: <br />City: <br />Telephone No.: <br />St.: Zip: <br />LOCATION: <br />The following information is required for all prospecting drill holes: <br />1/4 of the 1/4 of Section , Township , Range , <br />Prime Meridian, County. <br />If the area has not been surveyed, supply the Longitude West and Latitude North, <br />or attach a location map, preferably a USGS Quad. <br />The following additional information is required for artesian flowing holes: <br />Distances must be provided with an accuracy of ±200 feet (34-32-113(5.5)(d)) <br />feet ( ) north ( ) south from the ( ) south ( ) north section line <br />feet ( ) east ( ) west from the ( ) west ( ) east section line <br />NOTE: In the case of closely spaced drill holes having similar geologic and hydrologic characteristics, the Operator <br />may, with the approval of the Division, submit a single consolidated final report including the location of all <br />drill holes and a description of abandonment technique. In such a case, complete one abandonment final <br />report form and attach a list of drill hole locations. If more space is needed to provide any of the <br />information for this form, please attach separate sheets. <br />Date Permanently Abandoned: <br />DRILLER: <br />Name: <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines