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'IV <br />a <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 />I 7'. l.-? 1 i N 47= --'A of 1/0 v u .7. <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 Holes: Quantity Depth 1660 (ft) Diameter 3 (in) <br />C. Mud Pits: Quantity ___L._, Average Width (ft) Average Length _(ft) <br />Average Depth J- (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 pe, quantityL and general dimensions: <br />( <br />l_?'t eA .4-0 c A r4i m /t ek TUNnzz-1f' 1 ?1 t ' C x'?- (off <br />D. Other Disturbances (please describe): <br />---- -- -- ----- <br />E. Indicate Chemicals and Fuels used or stored on site. list ty e, quantity and method to store. <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: